Celiac disease in a rheumatology unit: a case study

Area of Science:

• Gastroenterology
• Rheumatology
• Immunology

Background:

• Celiac disease (CD) is an autoimmune disorder often diagnosed in childhood.
• Adult-onset CD can present with diverse symptoms, sometimes mimicking rheumatologic conditions.
• The association between CD and other autoimmune diseases, particularly connective tissue diseases, requires further investigation.

Purpose of the Study:

• To investigate the prevalence of celiac disease in adult patients attending a rheumatology unit.
• To compare clinical features and comorbidities of celiac patients managed by rheumatologists versus gastroenterologists.
• To highlight the diagnostic challenges and potential benefits of early CD diagnosis in a rheumatology setting.

Main Methods:

• Retrospective review of 20 adult celiac patients followed by a rheumatology unit (Group 1).
• Comparison with 40 adult celiac patients followed by a medicine department (Group 2).
• Data collected included reasons for rheumatologist evaluation, suggestive CD symptoms, obstetric history, and co-existing autoimmune diseases.

Main Results:

• Rheumatologists diagnosed celiac disease in 16 out of 20 patients.
• Fifteen patients in Group 1 had 17 concomitant autoimmune disorders, including nine connective tissue diseases.
• Arthralgias were the primary reason for rheumatologist evaluation; 10 patients had suggestive CD symptoms, and 8 had a history of sideropenic anemia. Three pregnancies resulted in live births after a gluten-free diet, contrasting with prior miscarriages.

Conclusions:

• Celiac disease frequently coexists with connective tissue diseases, presenting diagnostic challenges due to overlapping or atypical symptoms.
• Rheumatologists play a crucial role in identifying adult-onset celiac disease, especially when presenting with musculoskeletal complaints.
• Timely diagnosis and gluten-free dietary management can positively impact reproductive outcomes in women with celiac disease.