Unexplained polyarthralgia and celiac disease (original) (raw)
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Celiac disease association with other autoimmune disorders: Three case reports
Case Reports in Internal Medicine, 2014
Background: A 15 year period retrospective study at our celiac centre (Semmelweis University 2nd Department of Internal Medicine) has found, that 91 out of 248 coeliac patients (20 male, 71 female) also suffered from at least one autoimmune disease associated with celiac disease. The objective of the following case reports is to demonstrate the protean faces of celiac disease and the association tendency with other autoimmune disorders. Case presentation: 34-years old male patients presented with peripheral neuropathy. Results of electrophysiological studies were normal. Immunpanel examination was detected elevated tissue Transglutaminase antibodies levels. Duodenal biopsy revealed villous atrophy. Patient was started on strict gluten free diet and one year later he had almost complete recovery. 46-years-old male diagnosed with Dermatitis herpetiformis Duhring and celiac disease 20-years ago. In the last few years in spite of the gluten-free diet, he newly presented intestinal symptoms and chronic iron deficiency anaemia. The control tissue Transglutaminase antibodies, and duodenal biopsies were negative. Colonoscopy found inflammation in terminal ileum; video capsule endoscopy detected multiple ulcerative lesions in whole small bowel. The results confirmed the diagnosis of Crohn's disease. A 22-years old female patient diagnosed with celiac disease during the puerperium. The patient had muscles weakness, swallowing dysfunction, diplopia and generalized fatigue too. Muscle biopsies were normal. The electromyography was specific to myasthenia gravis. Computed tomography found thymus persistent. After tymectomy she showed good clinical response to immunosuppressant and cholinesterase inhibitor therapy. Conclusion: Autoimmune disorders have often been associated with celiac disease.
Sao Paulo Medical Journal, 2014
CONTEXT AND OBJECTIVE: Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients. DESIGN AND SETTING: Cross-sectional study in a public university hospital. METHODS: This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011. RESULTS: Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic in ltrate and villous atrophy. CONCLUSION: The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence.
Extraintestinal Manifestations of Celiac Disease
Digestive Diseases, 2015
quires a high degree of awareness of the clinical conditions that carry a high risk for underlying CD. Also, understanding the correct use of specific serology and duodenal histology is key for an appropriate diagnostic approach. Both procedures combined are able to confirm diagnosis in the vast majority of cases. However, in certain circumstances, serology and even duodenal histology cannot confirm or rule out CD. A common cause of negative IgA serology is IgA deficiency. For such eventuality, IgG-based serological tests can help confirm the diagnosis. Importantly, some histologically diagnosed cases still remain seronegative despite exclusion of IgA deficiency. On the other hand, duodenal histology may be normal despite the presence of CD-specific antibodies and active CD. This has been clearly demonstrated in some cases of untreated dermatitis herpetiformis, but may also be due to the patchy condition of CD or lesions that are not adequately recognized by nonexpert endoscopists and/or pathologists. The effectiveness of agluten-free diet depends on the clinical end point addressed. A good example is the outcome of bone loss. While risk for fracture normalizes after the first year of dietary treatment, bone parameters measured by densitometry may not be normalized in the long-term follow-up. Moreover, it is still unclear how far an early glutenfree diet will positively affect associated autoimmune diseases like type 1 diabetes and autoimmune thyroiditis.
Celiac disease: Do not miss that diagnosis!
The Egyptian Journal of Radiology and Nuclear Medicine, 2013
Background: Celiac disease (CD) is a chronic autoimmune disorder induced in genetically susceptible individuals after ingestion of gluten proteins Aim of the work: To highlight the utility of abdominal CT/enterography in diagnosis of CD. Subjects & methods: This retrospective study included 12 patients presented to our institute during the period from May 2011 till April 2013 with vague abdominal symptoms, performed abdominal CT/enterography. The final diagnosis was reached in all patients through upper GI endoscopy, duodenal biopsy and serological tests including anti-tissue transglutaminase and anti-endomysial antibodies. Results: The sensitivity of different CT signs was calculated against the diagnostic standard of reference (biopsy & serology). The jejuno-ileal fold reversal pattern was detected in 100% of patients. Other findings included (in descending order): Enlarged mesenteric lymph nodes in eight patients (66.5%); jejunal wall thickening, dilated jejunal loops, and cavitating lymph nodes in six patients (50%); dilated ileal loops in four patients (33%); ileal wall thickening in three patients (25%); thickened duodenum, and small bowel intussusception in two patients (16.5%). Conclusions: CT is an efficient imaging tool in diagnosis of CD. The jejuno-ileal fold reversal pattern is highly in favor of the diagnosis of CD.
Rheumatology International, 2013
Objective: To do a serological screening for celiac disease in patients with unexplained liver cytolysis. Materials and methods: Fifty-six patients with liver cytolysis without known aetiology were studied. Endomysial antibodies were determined by indirect immunofluorescence on human umbilical cord. Two thousand and five hundred blood donors served as control group. For statistical analysis, we used Chi-square or Fisher's exact test. Results: The frequency of IgA endomysial antibodies in our patients was significantly higher than in the control group (8.92% vs. 0.28%, p < .001). In female, endomysial antibodies were significantly more frequent in patients than in healthy subjects (12.12% vs. 0.4%; p < .001). In male, endomysial antibodies were significantly more frequent in patients than in healthy subjects (4.34% vs. 0.22%; p ¼ .006). The frequency of positive EMA in female patients was higher than in male, but the difference was not statistically significant (12.12% vs. 4.43%; p ¼ .6). Two patients were non-compliant with the gluten-free diet. One patient was out of touch. For the two other patients, transaminase levels reverted to normal level within six months of strict gluten withdrawal. Conclusions: A screening for celiac disease should be included within the diagnosis protocol of liver cytolysis.
Atypical presentations of celiac disease
ARS Medica Tomitana, 2016
In this study we evaluated the association of celiac disease in 81 children with autoimmune disease and genetic syndromes over a two years periods (January 2014 to July 2016) in Pediatric Clinic in Constanta. Because the extraintestinal symptoms are an atypical presentation of celiac disease we determined in these children the presence of celiac disease antibodies: Anti-tissue Transglutaminase Antibody IgA and IgA total serum level as a screening method followeds in selective cases by Anti-tissue Transglutaminase Antibody IgG, anti-endomysial antibodies, deamidated gliadin antibodies IgA and IgG and intestinal biopsia. In our study 8 patients had been diagnosed with celiac disease with extraintestinal symptoms, of which 4 with type 1 diabetes, 1 patient with ataxia, 2 patients with dermatitis herpetiformis and 1 patient with Down syndrome that associate also autoimmune thyroiditis, alopecia areata, enamel hypoplasia.
Celiac disease arthropathy and autoimmunity study
Journal of Gastroenterology and Hepatology, 2012
Background and Aim: To evaluate presence of sero-negative spondyloarthritis (SpA) in celiac disease (CD) patients, and whether compliance with a gluten free diet (GFD) improved arthritis manifestations in these patients. Methods: We undertook a prospective, questionnaire based, cross-sectional cohort study to evaluate the presence or absence of SpA simultaneously in both CD and non-CD cohorts. Results: 356/590 (60.3%) patients with CD participated in this study. 99% had diagnosis confirmed by a diagnostic test (79% small bowel biopsy, 19.8% blood test, 3.9% stool test). Approximately 131 (37%) cases of arthritis were reported in CD patients. Of the 6/356 CD patients with seronegative spondyloarthritides, four had sacroiliitis, two ankylosing spondylitis, and one psoriatic arthritis, compared to one ankylosing spondylitis and five psoriatic arthritis in non-CD. Osteoarthritis (89 vs 59, P = 0.93) was the most common diagnosis reported by respondents. More CD patients with diarrhea (94%) and anemia (81%) improved on GFD, compared to arthritis symptoms (30%). Autoimmune thyroiditis (10.6% vs 0.4%), insulin dependent diabetes mellitus (IDDM) (2.2% vs 1.7%), systemic Lupus erythematosus (SLE) (1.1% vs 0), and psoriasis (12.9% vs 5.5%) occurred more frequently in CD patients. The prevalence of Crohn's disease, ulcerative colitis, Sjogren's syndrome, primary biliary cirrhosis, and primary sclerosing cholangitis was around 1% each. Univariate Logistic regression analysis showed Յ high school education (odds ratio [OR] 2.01, P < 0.003), age Ն 60 years (OR 4.13, P < 0.001), and osteoporosis (OR 2.78, P < 0.001) to be significantly associated with report of arthritis in CD patients. Conclusion: We did not find a high rate of SpA in CD patients. In contrast, increased rates of autoimmune thyroiditis, SLE, IDDM, and psoriasis were seen in CD.
Journal of Contemporary Medicine, 2021
Objective: Celiac Disease (CD) which is an autoimmune disease affecting 1% of the population is associated with other autoimmune diseases and has extraintestinal manifestations. In the present study, we investigated the demographic and laboratory data of 94 patients and the association of celiac disease with anemia, osteoporosis and other autoimmune diseases. Material and Method: This study was conducted retrospectively by examining the records of 94 patients who were followed up with the diagnosis of CD between January 2014 and December 2019. Results: Of the patients, 74 were female (79%), 20 were male (21%). The mean age of the patients was 35 (18-73). The average disease duration was 6.6 years (0-29). Anti-endomysium Ig A positivity in 81 patients (86%), tissue transglutaminase Ig A positivity in 87 patients (93%), and tissue transglutaminase IgG positivity in 45 patients (48%) were detected. 14 patients had hypothyroidism (15%) and 8 patients had diabetes mellitus (9%). Osteoporosis or osteopenia was detected in 61 patients as the result of bone mineral densitometry (65%). According to the ferritin results, half of the patients and according to the transferrin saturation result, 47% had iron deficiency. 13 patients had B12 deficiency (14%) and 24 patients had folic acid deficiency (26%). Vitamin D deficiency was found in 74% of the patients. TSH value was found over 4.5 mIU/L in 10 patients. Conclusion: CD is associated with iron, folate, vitamin B12, and vitamin D deficiency and is associated with anemia and osteoporosis, and the disease is often accompanied by autoimmune thyroid diseases and diabetes.
Nonspecific Symptoms in Celiac Disease-Case Report
Celiac disease is an immune-mediated systemic disorder with a genetic predisposition. The availability of more specific serology tests showed that celiac disease is more common than previously suspected and that many patients do not demonstrate specific clinical or even histological sings. We present a case of celiac disease with the unset at 5 years, with recurrent episodes of diarrhea, weight loss and anemia. The serology tests showed a high level of IgA tissue transglutaminase antibodies, exceeding 10 times the upper limit but the intestinal biopsy showed normal size villi, intact surface epithelium and a lymphoplasmacytic infiltrate at chorionic level (Marsh 1). The diagnosis of celiac disease was confirmed by resolution of symptoms and normal tissue transglutaminase antibodies level, six month after starting the gluten free diet.