From the Guidelines
Celiac disease is most commonly associated with autoimmune conditions, including type 1 diabetes, autoimmune thyroid disease, autoimmune liver diseases, rheumatoid arthritis, and Sjögren's syndrome, as well as other conditions like dermatitis herpetiformis, iron deficiency anemia, osteoporosis, infertility, and neurological disorders. These associations occur because celiac disease shares genetic and immunological mechanisms with other autoimmune disorders, particularly through HLA-DQ2 and HLA-DQ8 genes 1. The chronic inflammation and malabsorption caused by celiac disease can lead to nutritional deficiencies that contribute to conditions like anemia and osteoporosis.
Some of the key conditions associated with celiac disease include:
- Autoimmune conditions: type 1 diabetes, autoimmune thyroid disease (both Hashimoto's thyroiditis and Graves' disease), autoimmune liver diseases, rheumatoid arthritis, and Sjögren's syndrome
- Dermatitis herpetiformis: an itchy skin rash
- Iron deficiency anemia
- Osteoporosis
- Infertility
- Neurological disorders: peripheral neuropathy and ataxia
- Down syndrome
Patients diagnosed with any of these conditions should be considered for celiac disease screening, especially if they have digestive symptoms or a family history of celiac disease, as early identification of these associated conditions is important for comprehensive management of celiac patients beyond just maintaining a gluten-free diet 1. According to the most recent evidence, the prevalence of osteoporosis in patients with celiac disease is significant, with approximately 28% of newly diagnosed patients having osteoporosis at the spine and 15% at the hip 1.
Given the potential for long-term complications, including malabsorption, anemia, and osteoporosis, it is crucial to prioritize the diagnosis and management of celiac disease, particularly in patients with associated conditions or risk factors 1. The American College of Gastroenterology recommends screening for celiac disease in patients with symptoms, signs, or laboratory evidence of malabsorption, as well as in those with a family history of the disease or other associated conditions 1.
From the Research
Conditions Associated with Celiac Disease
The following conditions are commonly associated with celiac disease (CD):
- Type 1 diabetes mellitus 2, 3, 4, 5, 6
- Inflammatory bowel disease 2, 3, 5
- Rheumatoid arthritis 2, 3
- Thyroid disorders 2, 3, 5, 6
- Nutritional deficiencies 2
- Gram-negative sepsis 2
- Autoimmune liver diseases 3, 5
- Primary biliary cirrhosis 3, 5
- Primary sclerosing cholangitis 5
- Osteoporosis 4, 5
- Iron-deficiency anemia 4, 6
- Neurological and psychiatric conditions 5
- Reproductive problems 5
- Malignant complications, including lymphoma 5
Autoimmune Associations
Celiac disease is associated with several autoimmune diseases, including:
- Type 1 diabetes mellitus, which shares a similar genetic base with CD 3, 4, 6
- Autoimmune thyroid disease, which has an increased prevalence in patients with CD 3, 5
- Rheumatoid arthritis, which has been found to co-exist with CD 2, 3
Clinical Implications
The presence of these associated conditions highlights the importance of:
- Screening high-risk patients for CD, such as those with autoimmune diseases 3, 4, 6
- Implementing a gluten-free diet to improve the overall clinical course and influence the evolution of associated diseases 6
- Recognizing co-morbidities to avoid attributing symptoms to deliberate or inadvertent ingestion of gluten, rather than prompting a search for a second diagnosis 5