Narrative Review: Celiac Disease: Understanding a Complex Autoimmune Disorder
Publication: Annals of Internal Medicine
Volume 142, Number 4
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Abstract
Celiac disease is a common autoimmune disorder that has genetic, environmental, and immunologic components. It is characterized by an immune response to ingested wheat gluten and related proteins of rye and barley that leads to inflammation, villous atrophy, and crypt hyperplasia in the intestine. The disease is closely associated with genes that code for human leukocyte antigens DQ2 and DQ8. Transglutaminase 2 appears to be an important component of the disease, both as a deamidating enzyme that can enhance the immunostimulatory effect of gluten and as a target autoantigen in the immune response. Sensitive and specific serologic tests, including those for anti–transglutaminase antibody, are facilitating fast and noninvasive screening for celiac disease. Thus, they are contributing to a more accurate estimate of the prevalence of the disease and its association with other disorders. Celiac disease is associated with increased rates of anemia, osteoporosis, cancer, neurologic deficits, and additional autoimmune disorders. A gluten-free diet is the mainstay of safe and effective treatment of celiac disease, although its effect on some of the extraintestinal manifestations of the disease remains to be determined.
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Published In
Annals of Internal Medicine
Volume 142 • Number 4 • 15 February 2005
Pages: 289 - 298
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Published online: 15 February 2005
Published in issue: 15 February 2005
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© 2005 American College of Physicians.
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Narrative Review: Celiac Disease: Understanding a Complex Autoimmune Disorder. Ann Intern Med.2005;142:289-298. [Epub 15 February 2005]. doi:10.7326/0003-4819-142-4-200502150-00011
Narrative Review: Celiac Disease: Understanding a Complex Autoimmune Disorder. Ann Intern Med.2005;142:289-298. [Epub 15 February 2005]. doi:10.7326/0003-4819-142-4-200502150-00011
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Celiac disease and anorexia nervosa
TO THE EDITOR: In their review (1), Alaedini and Green, among the disorders associated with celiac disease, do not mention anorexia nervosa. Although data in literature are based only on case reports (2), the association between anorexia nervosa and celiac disease should deserve attention: the dietary restriction associated with a gluten-free diet could initiate an eating disorder; furthermore, in patients with a defined diagnosis of anorexia nervosa, the onset of celiac disease could increase the medical complications associated with anorexia. Thus, celiac disease should be considered in the differential diagnosis of eating disorders (3) but physicians should also be extremely vigilant for the diagnosis of anorexia nervosa in patients with celiac disease.
Luca Mascitelli, MD Comando Brigata alpina "Julia" Udine, Italy 33100
Francesca Pezzetta, MD Ospedale di San Vito al Tagliamento San Vito al Tagliamento, Italy 33078
REFERENCES
1. Alaedini A, Green PH. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005;142:289- 98.
2. Ricca V, Mannucci E, Calabrò A, Bernardo MD, Cabras PL, Rotella CM. Anorexia nervosa and celiac disease: two case reports. Int J Eat Disord. 2000;27:119-22.
3. Levine RL. Endocrine aspects of eating disoredrs in adolescents. Adolesc Med. 2002;13:129-43.
Conflict of Interest:
None declared
The Association of Celiac Disease and Arthritis
TO THE EDITOR: Arthritis should be added to the group of disorders associated with celiac disease in the review by Alaedini and Green (1). Lubrano et al. (2) reported that arthritis was found in 52 out of 200 patients with celiac disease compared to 7 out of 40 control patients with irritable bowel syndrome. The most common patterns of arthritis included asymmetrical oligo/polyarthritis, spondyloarthritis, or an overlap of these two patterns. The arthritis is non-erosive and typically involves the shoulders, elbows, wrists, and knees (2). Other reports have supported the association of both synovitis (3) and sacroiliitis (4) with celiac disease. A more recent review by Slot and Locht (5) suggests that arthritis may be the presenting manifestation of celiac disease, even in the absence of typical gastro-intestinal symptoms. As with other manifestations of the celiac disease, the arthritis often remits with a gluten-free diet, although relapse may occur with dietary indiscretion (5).
References
1. Alaedini A, Green PH. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005;142:289- 98.
2. Lubrano E, Ciacci C, Ames PRJ, Mazzacca G, Oriente P, Scarpa R. Clinical review: the arthritis of coeliac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996;35:1314-18.
3. Bourne JT, Kumar P, Huskisson EC, Mageed R, Unworth DJ, Wojtulewski JA. Arthritis and coeliac disease. Ann Rheum Dis 1985;44:592- 8.
4. Usai P, Boi MF, Piga M, Cacace E, Lai MA, Beccaris A et al. Adult celiac disease is frequently associated with sacroiliitis. Dig Dis Sci 1995;40:1906-8.
5. Slot O, Locht H. Arthritis as presenting symptom in slient adult celiac disease: two cases and review of the literature. Scand J Rheumatol 2000;29:260-3.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Conflict of Interest:
None declared