RESUMEN
Aim: To assess the prevalence of celiac disease [CD] serological markers in a cohort of patients referred to an Italian rheumatological outpatient clinic
Background: Current guidelines do not suggest CD screening in patients with rheumatological diseases and these subjects are not considered to be at high risk for CD
Methods: A total of 230 sera of rheumatological patients referred to the Division of Internal Medicine at the Department of Medical and Surgical Sciences between January 2005 and December 2013 were screened for CD by testing IgA antitransglutaminase [TTG IgA], IgG deamidated gliadin peptides [DGP IgG] and IgA antiendomysium [EMA] antibodies. Of the 230 patients tested, 67 had a diagnosis of rheumatoid arthritis [RA], 52 Sjögren's syndrome [SjS], 42 systemic sclerosis [SCL], 35 systemic lupus erythematosus [SLE], 15 mixed connective tissue disease, 11 polymyositis and 10 dermatomyositis
Results: TTG IgA antibodies were identified in 7/230 cases [3%], 3 in SjS [3/42 - 5.8%], 2 in SCL [2/42 - 4.8%], 1 in RA [1/67 - 1.5%] and 1 in SLE sera [1/35 - 2.8%]. All the seven sera were also positive for DGP IgG and EMA IgA. DGP IgG were the most frequent antibody detected, being found in 16 [7%] sera
Conclusion: This study identified a high prevalence of CD antibodies in adult patients referred to a rheumatology outpatient clinic.These results highlight the importance of CD screening in subjects presenting with rheumatological features
RESUMEN
Non-celiac gluten sensitivity and celiac disease are known to be two distinct clinical entities, however, non-celiac gluten sensitivity has been detected in a proportion of first-degree relatives of celiac patients. Herein for the first time we describe the occurrence of asymptomatic celiac disease in two siblings, a girl and a boy, whose mother suffered from a proven non-celiac gluten sensitivity. Both the 12-year old girl and 9-year old boy were positive for anti-endomysial and anti-tissue transglutaminase antibodies of IgA class at a very high and low titer, respectively. Duodenal biopsy confirmed the diagnosis of active celiac disease [severe villous flattening] in the girl, whereas her brother had Marsh 1 lesion consistent with a potential celiac disease. This case report indicates that antibody screening for celiac disease can be recommended in any symptomatic or asymptomatic first-degree relatives of patients with nonceliac gluten sensitivity