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Gluten sensitivity masquerading as systemic lupus erythematosus
M Hadjivassiliou1, D S Sanders, R A Grünewald
1Department of Neurology, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. m.hadjivassiliou@sheffield.ac.uk
Annals of the Rheumatic Diseases
|October 14, 2004
Summary
Misdiagnosed systemic lupus erythematosus cases were correctly identified as gluten sensitivity after years of immunosuppressive treatment. Recognizing diverse gluten sensitivity symptoms is crucial for accurate diagnosis and avoiding prolonged, incorrect therapies.
Area of Science:
- Immunology
- Gastroenterology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse clinical manifestations.
- Gluten sensitivity can present with a wide range of symptoms, sometimes mimicking other immune-mediated disorders.
- Accurate diagnosis of gluten sensitivity is essential to prevent unnecessary immunosuppressive treatments.
Observation:
- Three patients initially diagnosed with SLE due to their presentation and immunological profiles were studied.
- These patients received prolonged treatment with steroids and immunosuppressive drugs for their presumed SLE.
- The correct diagnosis of gluten sensitivity was established after a significant delay.
Findings:
- Specific immunological markers such as IgA deficiency and/or elevated double-stranded DNA antibodies (in the absence of antinuclear factor) alongside inflammatory markers can suggest gluten sensitivity.
- An enteropathy is not a prerequisite for diagnosing gluten sensitivity, as it can manifest solely through extraintestinal symptoms.
- The study highlights the potential for gluten sensitivity to be misdiagnosed as SLE.
Implications:
- Physicians should consider gluten sensitivity in patients with an immune diathesis, particularly those with IgA deficiency or specific antibody profiles.
- Awareness of the varied extraintestinal presentations of gluten sensitivity is vital for timely and correct diagnosis.
- This knowledge can prevent misdiagnosis and guide appropriate management, avoiding the risks associated with long-term immunosuppression for conditions like SLE.