Study of serology and genetics of celiac disease in patients with juvenile systemic lupus erythematosus 'celiac in juvenile systemic lupus'

Introduction Several case reports and case series have suggested a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE). Patients with CD developing SLE and vice versa have been reported, highlighting a possible association. Up to 23% of patients with CD have raised anti-double-stranded DNA and likewise 5-22% of SLE patients are seropositive for CD. Objective Aim was to screen for CD in the serum of patients suffering from juvenile SLE (JSLE). Methods One hundred JSLE patients and 40 (age- and sex-matched) healthy subjects were subjected to laboratory screening for CD, endoscopic examination and histopathological examination of the duodenal biopsies to confirm CD diagnosis (in seropositive cases only). Results tTG Ab tested positive in 10% and negative in 90% of patients. tTG Ab correlated significantly with Systemic Lupus Erythematosus Disease Activity Index score (P< 0.001) and insignificantly with hemoglobin and C-reactive protein. Esophago-gastro-duodenoscopy was done to all 10 patients with positive serology for CD revealing six patients with manifest celiac (positive serology and positive endoscopy/biopsy) and four cases of latent celiac (positive serology and negative endoscopy/biopsy). Conclusion Most CD patients with articular symptoms remain undiagnosed, which makes screening justified in high-risk patients with autoimmune diseases. This study highlights the strong relationship between JSLE and CD and the need to screen JSLE patients and also other auto-immune rheumatic diseases for the concomitant existence of CD.