Original Article

Rheumatology International

, Volume 34, Issue 5, pp 637-642

First online:

Screening for celiac disease, by endomysial antibodies, in patients with unexplained articular manifestations

  • Mariam GhozziAffiliated withDepartment of Immunology, Farhat Hached University Hospital
  • , Wahiba SaklyAffiliated withResearch Unit (03/UR/07-02), Faculty of Pharmacy, Monastir University
  • , Amani MankaïAffiliated withResearch Unit (03/UR/07-02), Faculty of Pharmacy, Monastir UniversityHigh School of Sciences and Techniques of Health, Tunis el Manar University
  • , Elyes BouajinaAffiliated withDepartment of Rheumatology, Farhat Hached University Hospital
  • , Fethi BahriAffiliated withDepartment of Internal Medicine, Farhat Hached University Hospital
  • , Rafiaa NouiraAffiliated withDepartment of Dermatology, Farhat Hached University Hospital
  • , Chedia KechridAffiliated withDepartment of Internal Medicine, Sahloul University Hospital
  • , Ibtissem GhediraAffiliated withDepartment of Immunology, Farhat Hached University HospitalResearch Unit (03/UR/07-02), Faculty of Pharmacy, Monastir UniversityLaboratory of Immunology, Farhat Hached Hospital Email author 

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Celiac disease (CD) is an autoimmune systemic disease characterized by not only gastrointestinal but also extraintestinal manifestations. The aim of our study was to do a serological screening for CD, by IgA endomysial antibodies (EmA), in patients with unexplained articular manifestations. Two hundred and eleven patients suffering from arthritis or arthralgia without evident cause were studied. EmA were determined by indirect immunofluorescence on human umbilical cord. Two thousand and five hundred blood donors served as control group. Out of 211 patients, 5 had EmA (2.37 %). The frequency of EmA in our patients was significantly higher than in the control group (2.37 vs. 0.28 %, p < 0.01). All patients with positive EmA were female. EmA were significantly more frequent in female patients than in female healthy subjects (3 vs. 0.4 %, p < 0.01). Medical records revealed: diarrhea (one patient), short size (one patient), anemia (three patients), weight loss (two patients) spontaneous abortion (three patients), secondary amenorrhea (one patient), early menopause (one patient) and early baby death (one patient). Biochemical analysis showed decreased level of calcium (one patient), vitamin D (one patient) and cholesterol (one patient). Unexplained liver cytolysis was observed in two patients. Radiological examination showed demineralization of two hands in one patient. Bone osteodensitometry done in one patient out of five revealed lumbar osteopenia. The articular manifestations of the five patients did not respond to corticosteroid treatment. CD must be considered among the differential diagnosis in a patient with arthritis or arthralgia.


Arthritis Arthralgia Endomysial antibodies Celiac disease Adults