Celiac Disease Prevalence is Increased in Primary Sjögren's Syndrome and Diffuse Systemic Sclerosis: Lessons from a...

Area of Science:

• Gastroenterology and Immunology
• Rheumatology
• Autoimmune Diseases

Background:

• The association between celiac disease (CD) and systemic autoimmune diseases (ADs) is debated.
• Increased awareness of CD in AD patients is crucial for preventing complications like lymphoproliferative disorders.

Purpose of the Study:

• To evaluate the prevalence of previously diagnosed and subclinical celiac disease (CD) in patients with systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS), and systemic sclerosis (SSc).
• To compare CD prevalence in these AD cohorts against a large control group.

Main Methods:

• Collected data from 1458 unselected patients with SLE, pSS, and SSc.
• Screened patients for previously diagnosed CD and tested those without a diagnosis for IgA transglutaminase and anti-endomysium antibodies.
• Performed duodenal biopsies for confirmation in positive cases.
• Compared CD prevalence with 14,298 matched controls.

Main Results:

• CD prevalence was significantly higher in pSS (6.78%) compared to controls (0.64%, p < 0.0001).
• A trend towards higher CD prevalence was noted in SLE (1.38%) and SSc (1.34%).
• Diffuse cutaneous SSc showed a significantly higher CD prevalence (4.5%, p ≤ 0.002). Subclinical CD was identified in SLE and pSS patients.

Conclusions:

• Celiac disease prevalence is markedly increased in primary Sjögren's syndrome and diffuse systemic sclerosis.
• The findings suggest distinct immunopathogenic mechanisms in different SSc subsets.
• Consider CD screening in young patients with pSS and diffuse SSc, especially at diagnosis.