Dermatomyositis Associated with Celiac Disease: Response to a Gluten-Free Diet

Celiac disease (CD) is frequently accompanied by a variety of extradigestive manifestations, thus making it a systemic disease rather than a disease limited to the gastrointestinal tract. This is primarily explained by the fact that CD belongs to the group of autoimmune diseases. The only one with a known etiology is related to a permanent intolerance to gluten. Remarkable breakthroughs have been achieved in the last decades, due to a greater interest in the diagnosis of atypical and asymptomatic patients, which are more frequent in adults. The known presence of several associated diseases provides guidance in the search of oligosymptomatic cases as well as studies performed in relatives of patients with CD. The causes for the onset and manifestation of associated diseases are diverse; some share a similar genetic base, like type 1 diabetes mellitus (T1D); others share pathogenic mechanisms, and yet, others are of unknown nature. General practitioners and other specialists must remember that CD may debut with extraintestinal manifestations, and associated illnesses may appear both at the time of diagnosis and throughout the evolution of the disease. The implementation of a gluten-free diet (GFD) improves the overall clinical course and influences the evolution of the associated diseases. In some cases, such as iron deficiency anemia, the GFD contributes to its disappearance. In other disorders, like T1D, this allows a better control of the disease. In several other complications and/or associated diseases, an adequate adherence to a GFD may slow down their evolution, especially if implemented during an early stage.

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“…Some reports have suggested an association between this condition and CD [135, 137, 138] with response to GFD [138]. …”

Section: Autoimmune Disorders In Celiac Diseasementioning

confidence: 99%

Celiac Disease and Autoimmune-Associated Conditions

Lauret

Rodrigo

2013

BioMed Research International

152

111

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“…The prevalence of rheumatoid arthritis is not increased in celiac disease [44]. Sjogren's syndrome [45], primary hyperparathyroidism [46], hypoparathyroidism [47], hypopituitarism [48] and systemic lupus erythematosus [49,50] have all been described in association with celiac disease, but usually in a small series or case reports.…”

Section: Other Autoimmune Diseasesmentioning

confidence: 99%

Risk of morbidity in contemporary celiac disease

Lewis

Holmes

2010

Expert Review of Gastroenterology & Hepatology

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Celiac disease is one of the most common chronic diseases encountered in the Western world with a serological prevalence of approximately 1%. Since it is so common, much comorbidity will occur either as associations or simply by chance, or as complications of the disorder. Many of the published studies purporting to establish the frequency of these occurrences have been limited by factors such as the source and number of patients considered, choice of control groups and ascertainment bias. Recent epidemiological studies have attempted to minimize these sources of error and provide more reliable information. Autoimmune diseases constitute clinically important associations, of which Type 1 diabetes mellitus and thyroid disorders are the most important. Several liver disorders, including primary biliary cirrhosis and primary sclerosing cholangitis, are also associated. The frequency of malignant complications of celiac disease is much lower than earlier studies have indicated, with lymphoma increased by approximately fivefold and the absolute number of tumors is small. The increase in fracture risk in celiac disease is only modest. Although neurological and psychiatric conditions affect celiac patients, no disorder specifically associated with celiac disease has been identified. Reproductive problems have been overexaggerated. It is important that these co-morbidities are recognized because if not, symptoms will be falsely attributed to deliberate or inadvertent ingestion of gluten, rather than prompt a search for a second diagnosis. Furthermore, in a patient with an established diagnosis that is considered falsely to account for the whole clinical picture, celiac disease is likely to remain undetected.

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“…En relación a las miositis, en nuestra población, se detectó un paciente con EC y PM. La asociación entre miopatías inflamatorias y EC ha sido documentada en niños 17,18 y adultos 19 . Otros autores, que evaluaron los títulos de autoanticuerpos para múltiples enfermedades autoinmunes en pacientes con miopatías inflamatorias; observaron que los anticuerpos para antigliadina y anti-tTG fueron más prevalentes en pacientes con miopatías inflamatorias comparados con los controles 20 .…”

Section: Discussionunclassified