Rheumatology International

, Volume 34, Issue 5, pp 637–642 | Cite as

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

  • Mariam Ghozzi
  • Wahiba Sakly
  • Amani Mankaï
  • Elyes Bouajina
  • Fethi Bahri
  • Rafiaa Nouira
  • Chedia Kechrid
  • Ibtissem Ghedira
Original Article

Abstract

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.

Keywords

Arthritis Arthralgia Endomysial antibodies Celiac disease Adults 

References

  1. 1.
    Sollid LM, Jabri B (2013) Triggers and drivers of autoimmunity: lessons from coeliac disease. Nat Rev Immunol 13:294–302PubMedCrossRefGoogle Scholar
  2. 2.
    Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP, ESPGHAN Working Group on Coeliac Disease Diagnosis, ESPGHAN Gastroenterology Committee, European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (2012) European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54:136–160PubMedCrossRefGoogle Scholar
  3. 3.
    Mäki M (2012) Coeliac disease: lack of consensus regarding definitions of coeliac disease. Nat Rev Gastroenterol Hepatol 9:305–306PubMedCrossRefGoogle Scholar
  4. 4.
    Adelizzi RA, Pecora AA, Chiesa JC (1982) Celiac disease: case report with an associated arthropathy. Am J Gastroenterol 77:481–485PubMedGoogle Scholar
  5. 5.
    Bourne JT, Kumar P, Huskisson EC, Mageed R, Unsworth DJ, Wojtulewski JA (1985) Arthritis and coeliac disease. Ann Rheum Dis 44:592–598PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Slot O, Locht H (2000) Arthritis as presenting symptom in silent adult coeliac disease. Two cases and review of the literature. Scand J Rheumatol 29:260–263PubMedCrossRefGoogle Scholar
  7. 7.
    Hepburn AL, Kaye SA (2001) Oligoarthritis in an elderly woman with diarrhoea and weight loss. Postgrad Med J 77:475–477PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Iqbal T, Zaidi MA, Wells GA, Karsh J (2013) Celiac disease arthropathy and autoimmunity study. J Gastroenterol Hepatol 28:99–105PubMedCrossRefGoogle Scholar
  9. 9.
    Lubrano E, Ciacci C, Ames PR, Mazzacca G, Oriente P, Scarpa R (1996) The arthritis of coeliac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 35:1314–1318PubMedCrossRefGoogle Scholar
  10. 10.
    Prier A, Le Quintrec Y, Camus JP, Gendre JP, Pradel B (1980) Inflammatory polyarthritis associated with villous atrophy of the small intestine. Study of 2 cases. Rev Rhum Mal Osteoartic 47:661–665PubMedGoogle Scholar
  11. 11.
    Borg AA, Dawes PT, Swan CH, Hothersall TE (1994) Persistent monoarthritis and occult coeliac disease. Postgrad Med J 70:51–53PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588PubMedCrossRefGoogle Scholar
  13. 13.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725PubMedCrossRefGoogle Scholar
  14. 14.
    Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sørensen IJ, Ozgocmen S, Roussou E, Valle-Oñate R, Weber U, Wei J, Sieper J (2009) The development of assessment of spondylo arthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783PubMedCrossRefGoogle Scholar
  15. 15.
    Veale D, Rogers S, Fitzgerald O (1994) Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol 33:133–138PubMedCrossRefGoogle Scholar
  16. 16.
    Mankaï A, Landolsi H, Chahed A, Gueddah L, Limem M, Ben Abdessalem M, Yacoub-Jemni S, Ghannem H, Jeddi M, Ghedira I (2006) Celiac disease in Tunisia: serological screening in healthy blood donors. Pathol Biol 54:10–13PubMedCrossRefGoogle Scholar
  17. 17.
    Ghedira I, Sghiri R, Ayadi A, Sfar MT, Harbi A, Essoussi AS, Amri F, Korbi S, Jeddi M (2001) Anti-endomysium, anti-reticulin and anti-gliadin antibodies, value in the diagnosis of celiac disease in the child. Pathol Biol 49:47–52PubMedCrossRefGoogle Scholar
  18. 18.
    Dawidowicz K, Ea HK, Lahalle S, Qubaja M, Lioté F (2008) Unexplained polyarthralgia and celiac disease. Joint Bone Spine 75:325–328PubMedCrossRefGoogle Scholar
  19. 19.
    Collin P, Korpela M, Hällström O, Viander M, Keyriläinen O, Mäki M (1992) Rheumatic complaints as a presenting symptom in patients with coeliac disease. Scand J Rheumatol 21:20–23PubMedCrossRefGoogle Scholar
  20. 20.
    Lionetti E, Catassi C (2011) New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment. Int Rev Immunol 30:219–231PubMedCrossRefGoogle Scholar
  21. 21.
    Bürgin-Wolff A, Mauro B, Faruk H (2013) Intestinal biopsy is not always required to diagnose celiac disease: a retrospective analysis of combined antibody tests. BMC Gastroenterol 13:19PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Ladinser B, Rossipal E, Pittschieler K (1994) Endomysium antibodies in coeliac disease: an improved method. Gut 35:776–778PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Chow MA, Lebwohl B, Reilly NR, Green PH (2012) Immunoglobulin A deficiency in celiac disease. J Clin Gastroenterol 46:850–854PubMedCrossRefGoogle Scholar
  24. 24.
    Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG, North American Society for Pediatric Gastroenterology, Hepatology, Nutrition (2005) Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 40:1–19PubMedCrossRefGoogle Scholar
  25. 25.
    Vilppula A, Kaukinen K, Luostarinen L, Krekela I, Patrikainen H, Valve R, Mäki M, Collin P (2009) Increasing prevalence and high incidence of celiac disease in elderly people: a population-based study. BMC Gastroenterol 9:49–54PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Rubio-Tapia A, Murray JA (2007) The liver in celiac disease. Hepatology 46:1650–1658PubMedCrossRefGoogle Scholar
  27. 27.
    Landolsi H, Bouajina E, Mankaï A, Zeglaoui H, Skandrani K, Ghedira I (2006) Severe osteomalacia due to undiagnosed coeliac disease: three case reports of Tunisian women. Rheumatol Int 26:261–263PubMedCrossRefGoogle Scholar
  28. 28.
    Freeman HJ (2010) Reproductive changes associated with celiac disease. World J Gastroenterol 16:5810–5814PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Zeglaoui H, Landolsi H, Mankai A, Ghedira I, Bouajina E (2010) Type 1 diabetes mellitus, celiac disease, systemic lupus erythematosus and systemic scleroderma in a 15-year-old girl. Rheumatol Int 30:793–795PubMedCrossRefGoogle Scholar
  30. 30.
    Campisi G, Di Liberto C, Iacono G, Compilato D, Di Prima L, Calvino F, Di Marco V, Lo Muzio L, Sferrazza C, Scalici C, Craxì A, Carroccio A (2007) Oral pathology in untreated coeliac disease. Aliment Pharmacol Ther 26:1529–1536PubMedCrossRefGoogle Scholar
  31. 31.
    Krifa FL, Sakly W, Ghedira I, Essoussi AS, Boukadida J, Ben Hadj Hamida F (2010) Uveitis responding on gluten free diet in a girl with celiac disease and diabetes mellitus type 1. Gastroenterol Clin Biol 34:319–320PubMedCrossRefGoogle Scholar
  32. 32.
    Ivarsson A, Hernell O, Stenlund H, Persson LA (2002) Breast-feeding protects against celiac disease. Am J Clin Nutr 75:914–921PubMedGoogle Scholar
  33. 33.
    Norris JM, Barriga K, Hoffenberg EJ, Taki I, Miao D, Haas JE, Emery LM, Sokol RJ, Erlich HA, Eisenbarth GS, Rewers M (2005) Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA 93:2343–2351CrossRefGoogle Scholar
  34. 34.
    D’Amico MA, Holmes J, Stavropoulos SN, Frederick M, Levy J, DeFelice AR, Kazlow PG, Green PH (2005) Presentation of pediatric celiac disease in the United States: prominent effect of breastfeeding. Clin Pediatr (Phila) 44:249–258CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Mariam Ghozzi
    • 1
  • Wahiba Sakly
    • 2
  • Amani Mankaï
    • 2
    • 3
  • Elyes Bouajina
    • 4
  • Fethi Bahri
    • 5
  • Rafiaa Nouira
    • 6
  • Chedia Kechrid
    • 7
  • Ibtissem Ghedira
    • 1
    • 2
    • 8
  1. 1.Department of ImmunologyFarhat Hached University HospitalSousseTunisia
  2. 2.Research Unit (03/UR/07-02), Faculty of PharmacyMonastir UniversityMonastirTunisia
  3. 3.High School of Sciences and Techniques of HealthTunis el Manar UniversityTunisTunisia
  4. 4.Department of RheumatologyFarhat Hached University HospitalSousseTunisia
  5. 5.Department of Internal MedicineFarhat Hached University HospitalSousseTunisia
  6. 6.Department of DermatologyFarhat Hached University HospitalSousseTunisia
  7. 7.Department of Internal MedicineSahloul University HospitalSousseTunisia
  8. 8.Laboratory of ImmunologyFarhat Hached HospitalSousseTunisia

Personalised recommendations