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 (tTG-IgA) within one year of SLE diagnosis. We recorded tTG-IgA titers and reviewed medical records for additional investigations, including pathology reports of duodenal biopsies. CD was confirmed by duodenal histology based on the modified Marsh-Oberhuber classification (Marsh ≥3). Demographic and SLE disease features were extracted from the dedicated Lupus database. We calculated the prevalence of clinical features, positive tTG-IgA results, and biopsy-confirmed CD, and compared SLE features between CD and non-CD groups with Fisher’s exact tests.

Results: CD screening was completed in 74% (300/404) of children diagnosed with SLE. Thirteen (4%) had positive tTG-IgA serology (ranging from 38 to >100 U/ml [positive >8U/ml] for Enzyme-linked immunoassay testing and 34 to >4965 CU [positive >30 CU] using the Chemiluminescent Immunoassay). Ten of 13 (77%) patients with positive anti-tTG autoantibodies had an endoscopy and duodenal biopsy. Of those biopsied, eight had histopathologic evidence of CD which represents 62% of patients with positive serology, and 2.6% of the screened SLE population. Among patients with CD, only 50% had GI symptoms and 62% (8/13) had positive anti-endomysial antibodies. All patients with biopsy-proven CD were diagnosed within one year of SLE diagnosis. There were no significant differences in SLE features observed between those with and without CD.

Conclusion: Biopsy-proven CD was diagnosed in 2.6% of children and adolescents with SLE, which is higher than the reported prevalence in the general population of 1.4% by seroprevalence and 0.7% by biopsy. Only half of the patients with biopsy-proven CD had GI symptoms, highlighting the utility of screening in the childhood SLE population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-celiac-disease-among-children-and-adolescents-with-systemic-lupus-erythematosus-sle-2/