Increased prevalence of celiac disease in idiopathic inflammatory myopathies

Abstract

ObjectivesIdiopathic inflammatory myopathies (IIM) are often associated with other immune‐mediated diseases or malignancy. Some studies have reported a high frequency of celiac disease in IIM. The aim of this study was to investigate the prevalence of celiac disease, systemic inflammatory diseases, and malignancy in a cohort of IIM patients, and estimate the incidence of IIM in the county of Östergötland, Sweden.Material and MethodsWe reviewed medical records and analyzed sera from 106 patients, fulfilling pathological criteria of inflammatory myopathy, for the presence of IgA antibodies against endomysium and gliadin. Antibody‐positive patients were offered further investigation with small bowel biopsy or investigation for the presence of antibodies against antitissue transglutaminase (t‐TG). The patients were classified according to Bohan and Peter or Griggs criteria. The presence of celiac disease, systemic inflammatory, and malignant diseases was documented.ResultsFour of 88 patients classified as IIM (4.5%) had biopsy‐confirmed celiac disease, which is higher than the prevalence in the general population, detected with a similar screening procedure (0.53%). Thirty‐three patients (38%) had a systemic inflammatory disease and five (5.7%) a malignancy. The incidence of confirmed IIM in the county of Östergötland was 7.3 per million/year.ConclusionsThe results highlight the high frequency of associated inflammatory and malignant diseases and confirm an increased prevalence of celiac disease in IIM.

The Neuropathology of Gluten-Related Neurological Disorders: A Systematic Review

“…A consistent finding in three of the ataxia studies was the presence of diffuse infiltrates and perivascular cuffing with lymphocytes in the cerebellar tissue [9,14,15,18]. Lymphocytic infiltration was also demonstrated in several nerve biopsies of patients with neuropathy [17,22,25], muscle biopsies of myopathy patients [26,27,30,32] and in brain tissue of patients with encephalopathy [33,35] and epilepsy [42]. Characterization of these cell infiltrates was only performed by Mittelbronn et al [15] who described a cytotoxic T-cell population (CD8+ and granzyme B+), and by Souayah (CD68+/CD45ro+ cell populations) [22].…”

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“…It was unexpected that of the 151 diagnoses declared in G1, 24.7% referred to neurological manifestations ( p < 0001). These kind of manifestations of gluten sensitivity, like ataxia [ 15 ], epilepsy [ 16 ], peripheral neuropathy [ 17 ] or myopathy [ 18 ] have been described for many years [ 19 ], but it is rather recently that symptoms like migraine [ 20 ] and anxiety/depression [ 21 ] are described in association with CD and NCGS [ 22 ]. Autoimmune, genetic, epigenetic, microbiome and other interactions play relevant roles in CD pathophysiology, but the mechanisms explaining the relationship between CD and other conditions characterized by gluten sensitivity—like neurological manifestations of gluten sensitivity—are still incompletely understood [ 23 ].…”

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“…Several studies show an increased prevalence of celiac disease in IIM [ 179 , 180 ]. Renal involvement develops in about one fifth of IIM patients [ [181] , [182] , [183] ].…”