Abstract
Recent studies report that in patients with Sjögren's syndrome (SS), concomitant coeliac disease (CD) is more frequent than in the average healthy population, with dominance of the latent/silent form. We further investigated this to characterise the clinical and immunolaboratory features of SS patients with CD. One hundred and eleven patients with SS were involved in the study. After detailed history, blood samples were taken for antibodies to gliadin, endomysium, and tissue transglutaminase. Of them, six had positive serology for CD and underwent jejunoscopy and small bowel biopsy to confirm the diagnosis of CD. In five patients, the diagnosis was established histologically. The frequency of CD in the SS population was significantly higher than in the non-SS European population (4.5:100 vs 4.5–5.5:1,000). Laboratory findings in these patients showed significantly higher erythrocyte sedimentation rates and IgG, IgA, and IgM levels. On the basis of these findings, we recommend screening, follow-up, and regular gastrointestinal care of SS patients to identify CD cases and help them to avoid severe malnutrition and intestinal malignancies.
Similar content being viewed by others
References
Cole SG, Kagnoff MP (1985) Celiac disease. Ann Rev Nutr 5:241–266
Barry RE, Baker P, Read AE (1974) Coeliac disease. The clinical presentation. Clin Gastroenterol 3:55–69
Ferguson A (1992) Definitions and diagnostic criteria of latent and potential coeliac disease. In: Auricchio S, Visakorpi JK (eds) Common food intolerances 1: epidemiology of coeliac disease. Karger, Basel, pp 119–127
Marsh MN (1992) Gluten sensitivity and latency: the histological background. In: Auricchio S, Visakorpi JK (eds) Common food intolerances 1: epidemiology of coeliac disease. Karger, Basel, pp 84–92
Kagnoff MF (1992) Role of environmental and genetic factors in coeliac disease. In: Branski D, Rozen P, Kagnoff MF (eds) Gluten-sensitive enteropathy. Frontiers of gastro-intestinal research. Karger, Basel, pp 15–28
Scott H, Nilsen E, Sollid LM, Lundin KE, Rugtveit J, Molberg O, Thorsby E, Brandtzaeg P (1997) Immunopathology of gluten-sensitive enteropathy. Semin Immunopathol 18:535–553
Lerner A, Blank M, Schoenfeld Y (1996) Celiac disease and autoimmunity. Isr J Med Sci 32:33–36
Jonsson R, Haga H-J, Gordon T (2001) Sjögren's syndrome. In: Koopman WJ (ed) Arthritis and allied conditions. A textbook of rheumatology, 14th edn. Lippincott Williams and Wilkins, Philadelphia, pp 1736–1759
Tsianos EB, Vasakos S, Drosos AA, Malamou-Mitsi VD, Moutsopoulos HM (1986) The gastrointestinal involvement in primary Sjögren's syndrome. Scand J Rheumatol 61:151–155
Teppo AM, Maury CP (1984) Antibodies to gliadin, gluten and reticulin glycoprotein in rheumatic diseases: elevated levels in Sjögren's syndrome. Clin Exp Immunol 57:73–78
Collin P, Korpela M, Hallstrom O, Viander M, Keyrilainen O, Maki M (1992) Rheumatic complaints as a presenting symptom in patients with coeliac disease. Scand J Rheumatol 21:20–23
Iltanen S, Collin P, Korpela M Holm K, Partanen J, Polvi A, Maki M (1999) Celiac disease and markers of celiac disease latency in patients with primary Sjögren's syndrome. Am J Gastroenterol 94:1042–1046
Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH, the European Study Group an Classification Criteria for Sjögren's Syndrome (2002) Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61:554–558
Ivarsson A, Persson LA, Juto P, Peltonen M, Suhr O, Hernell O (1999) High prevalence of undiagnosed coeliac disease in adults: a Swedish population-based study. J Intern Med 245:63–68
Cronin CC, Shanahan F (2001) Why is celiac disease so common in Ireland? Perspect Biol Med 44:342–352
Volta U, Bellentani S, Bianchi FB, Brandi G, De Franceschi L, Miglioli L, Granito A, Balli F, Tiribelli C (2001) High prevalence of celiac disease in the Italian general population. Dig Dis Sci 46:1500–1505
Sheikh SH, Shaw-Stiffel TA (1995) The gastrointestinal manifestations of Sjögren's syndrome. Am J Gastroenterol 90:9–14
Constantopoulos SH, Tsianos EV, Moutsopoulos HM (1992) Pulmonary and gastrointestinal manifestations of Sjögren's syndrome. Rheum Dis Clin North Am 18:617–635
Soulier C, Saraux A, Baron D, Robert FX, Leroy JP, Le Goff P (1996) Is collagenous colitis a new etiology of sicca syndrome? Rev Rhum Engl Ed 63:600–605
Sobhani I, Brousse N, Vissuzaine C, McIntyre E, Marmuse JP, Kahn MF, Potet F, Mignon M (1998) A diffuse T lymphocytic gastrointestinal mucosal infiltration associated with Sjögren's syndrome resulting in a watery diarrhea syndrome and responsive to immunosuppressive therapy. Am J Gastroenterol 93:2584–2586
Triantafillidis JK, Roussou P, Manousos ON, Dadioti P, Nicolakis D (1994) Ulcerative colitis and Sjögren's syndrome in the same patient: report of two cases and review of the literature. Ital J Gastroenterol 26:299–302
Acknowledgements
We wish to thank Professor Roland Jonsson (Broegelmann Research Laboratory, University of Bergen, Norway) for valuable discussions and advice on the article. This work was supported by grants from the National Research Fund (OTKA T026238) and the Ministry of Welfare (T 05 099).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Szodoray, P., Barta, Z., Lakos, G. et al. Coeliac disease in Sjögren's syndrome—a study of 111 Hungarian patients. Rheumatol Int 24, 278–282 (2004). https://doi.org/10.1007/s00296-003-0360-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-003-0360-x