Background/Purpose: Systemic lupus erythematosus (SLE) and celiac disease (CD) are autoimmune diseases characterized by the presence of specific autoantibodies. We aimed to investigate the prevalence of CD in a multiethnic cohort of children and adolescents with SLE.

Methods: We completed a retrospective cohort study of patients under 18 years of age who were diagnosed and followed for SLE at The Hospital for Sick Children between January 2010 and June 2022. We restricted to patients screened for CD with immunoglobulin A antibodies against tissue transglutaminase (anti-tTG-IgA) within one year of SLE diagnosis. We recorded anti-tTG-IgA titers and reviewed medical records for additional investigations, including duodenal biopsy results. CD was confirmed by biopsy according to the Marsh-Oberhuber classification (Marsh ≥3). Demographic and SLE disease features were extracted from the dedicated Lupus database. We calculated the prevalence of positive anti-tTG serology and biopsy-confirmed CD.

Results: CD screening was completed in 93% (374/404) of children diagnosed with SLE. Sixteen (4.2%) had positive anti-tTG-IgA serology (ranging from 31 to 100 U/ml [positive 8U/ml] for Enzyme-linked immunoassay testing and 34 to 4965 CU [positive 30 CU] using Chemiluminescent Immunoassay). 81% (13/16) also had positive anti-endomysial antibodies. Eleven of 16 (68.8%) patients with positive anti-tTG autoantibodies had an endoscopy and duodenal biopsy. Of those biopsied, nine had histopathologic evidence of CD which represents 56% of patients with positive serology, and 2.4% of the screened SLE population. Less than half (45%) of patients with CD had gastrointestinal complaints at screening.

Conclusion: Biopsy-confirmed CD was diagnosed in 2.4% of children and adolescents with SLE, which is higher than the prevalence in the general population of 1.4% by seroprevalence and 0.7% by biopsy. Less than half of patients with biopsy confirmed CD had GI symptoms, highlighting the utility of screening in the childhood SLE population. Future analyses will compare SLE features between those with and without CD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-celiac-disease-among-children-and-adolescents-with-systemic-lupus-erythematosus-sle/