Other Autoimmune Disease and More

The Gluten File

University of Chicago Celiac Disease Program Fact Sheet

Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease.

Emerging concepts in celiac disease by William Treem, MD

"The association of CD with autoimmune diseases, particularly Type 1 diabetes and autoimmune thyroid disease, has been widely reported with some investigators finding a ten-fold increase in patients with CD compared with the general population [68,69].Less clear is the link between CD and Sjögren syndrome, primary biliary cirrhosis, Addison disease, autoimmune chronic active hepatitis, cardiomyopathy, and peripheral neuropathy (not due to B-12 or vitamin E deficiency) [70–73•,74•].

When both CD and autoimmune disease occur in a patient, CD is most often silent.The autoimmune disease is diagnosed first with the diagnosis of CD the result of serologic screening in this high-risk population.

The question whether the early diagnosis and treatment of CD reduces the risk of developing other autoimmune  diseases is still open to debate.There are several lines of evidence that support the notion that CD is a causative factor in the development of other autoimmune diseases. A recent study suggests that the prevalence of autoimmune diseases is closely related to the duration of gluten exposure and the age of initiation of a GFD with children diagnosed and treated before 2 years of age having little subsequent increased risk [75].Older children diagnosed with CD have a higher than expected frequency of organ-specific autoantibodies that tend to disappear after starting a GFD.Anecdotal reports suggest that socalled "celiac neuropathy", IgA nephropathy, juvenile rheumatoid arthritis, and autoimmune myocarditis will all improve when patients who have underlying CD are maintained on a strict GFD [73•,74•,76,77]. "

PubMed Abstracts:

OBJECTIVE: Circulating immune complexes (CICs) in blood are associated with autoimmune-diseases such as systemic lupus erythematosus, immune complex glomerulonephritis, rheumatoid arthritis and vasculitis. However, slightly increased serum concentrations of such CICs are sometimes also found in healthy individuals. The objective of the current study was to assess whether food antigens could play a role in the formation of CICs.

CONCLUSIONS: The results of this study indicate that certain food antigens (e.g. gluten) could play a role in the formation of CICs. An association between CICs and fructose or lactose malabsorption seems to be improbable.
Gliadin IgG antibodies and circulating immune complexes.
PMID: 18819035   2009 

MYO9B (myosin IXB) polymorphisms were associated with celiac disease and ulcerative colitis susceptibility, presumably through alteration of the intestinal permeability. Recently this gene was also associated with several diseases with an autoimmune component, such as rheumatoid arthritis and systemic lupus erythematosus. We aimed to test, for the first time, the potential role of MYO9B polymorphisms in type 1 diabetes (T1D), an autoimmune condition preceded by changes in intestinal barrier integrity. ... Our data suggest an involvement of this MYO9B chromosomal region in T1D predisposition, indicating extensive influence on autoimmune diseases.
Association of MYO9B haplotype with type 1 diabetes.
PMID: 18361936   Feb 2008

The cumulative risk of subsequent autoimmune disease was lower in patients compliant to a gluten-free diet versus noncompliant patients (at 10 years, 6% +/- 2% vs 15.6% +/- 5.9%, respectively; P = .02). The incidence of autoimmune diseases was 5.4 per 1000 patient-years during adherence to a gluten-free diet versus 11.3 per 1000 patient-years during nonadherence to the diet (P = .002). Results were similar in both the pediatric and the adult populations. CONCLUSIONS: Celiac patients most at risk for autoimmune disease are those diagnosed early in life and having a family history of autoimmunity. The gluten-free diet has a protective effect.
Incidence of Autoimmune Diseases in Celiac Disease: Protective Effect of the Gluten-Free Diet.
PMID: 18255352  Feb 2008

The most frequent reported CD associated conditions are type 1 diabetes mellitus and autoimmune thyroiditis. Associated autoimmune antibodies are frequent in CD and their first-degree relatives, spanning anti-endocrine, anti-gastrointestinal, anti-nuclear, anti-cytoskeleton and anti-neurological antibodies. More specifically, antibodies against thyroid and the endocrine pancreas, anti-gastric and liver, anti-nuclear constituents, anti-reticulin, actin, smooth muscle, calreticulin, desmin, collagens and bone, anti-brain, ganglioside, neuronal and blood vessel were described in sera of the patients in numerous studies.
Associated autoantibodies in celiac disease.
PMID: 17854749 Sept 2007

There is, however, growing evidence that the loss of the intestinal barrier function typical of celiac disease could be responsible of the onset of other autoimmune disease. This concept implies that the autoimmune response can be theoretically stopped and perhaps reversed if the interplay between autoimmune predisposing genes and trigger(s) is prevented or eliminated by a prompt diagnosis and treatment.
Systemic autoimmune disorders in celiac disease
PMID: 17053448 Nov 2006  Full text on Medscape

When the finely tuned trafficking of macromolecules is dysregulated in genetically susceptible individuals, both intestinal and extraintestinal autoimmune disorders can occur. This new paradigm subverts traditional theories underlying the development of autoimmunity, which are based on molecular mimicry and/or the bystander effect, and suggests that the autoimmune process can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function.
Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases.
PMID: 16265432  Sept 2005

Relatives of CD patients had an increased prevalence of AD compared to control groups, and relatives of CD patients with ADs, have a risk as high as 25% of being silent celiacs: they should thus be screened for CD. Relatives of CD patients had an increased prevalence of AD compared to control groups, and relatives of CD patients with ADs, have a risk as high as 25% of being silent celiacs: they should thus be screened for CD.
Prevalence of autoimmune disorders in relatives of patients with celiac disease.
PMID: 12141796 July 2002

Antigliadin antibodies (AGA) mark celiac disease, but AGA are also encountered in IgA-nephritis, psoriasis, sickle-cell anemia, hepatic disorders, juvenile rheumatoid arthritis, autoimmune thyroidism and in persons who occupationally contact great amounts of wheat.
Antigliadin antibodies in the absence of celiac disease.
PMID: 9553358  1998

Interactions between dietary proteins and the human system: implications for oral tolerance and food-related diseases.

Addison's disease

In this series of patients with Addison's disease, a higher co-morbidity with coeliac disease was observed than in any previously studied endocrine condition. We recommend that coeliac serology (anti-endomysial and tissue transglutaminase antibody) testing be incorporated routinely into the autoimmune screen for other conditions in patients with Addison's disease.
Coeliac disease and autoimmune Addison's disease: a clinical pitfall. Full text
PMID: 11861954  2002

Risk of Primary Adrenal Insufficiency in Patients with Celiac Disease
PMID: 17595243  2007

Alopecia areata and vitiligo

The results show that alopecia areata may constitute the only clinical manifestation of celiac disease and that the association between these two conditions is a real one because the observed frequency of association is much greater than can be expected by chance. It is suggested that antigliadin and antiendomysial antibodies should be included in the work-up of patients with alopecia areata.
Celiac disease and alopecia areata: report of a new association.
PMID: 7557104

Serological screening for coeliac disease in vitiligo and alopecia areata.
PMID: 9205530

Ankylosing Spondylitis

The Significance of Coeliac Disease Antibodies in Patients with Ankylosing Spondylitis: a Case-controlled Study.
PMID: 19215694   Jan 2009

Antiphospholipid Syndrome

Discussion: antiphospholipid syndrome is characterized by arterial and venous thrombosis, and spontaneous fetal death. Its association with celiac disease has been described in few cases. Celiac disease is associated with spontaneous fetal death; consequently, we hypothesize that antiphospholipid syndrome may be one of the causes for this event.
Celiac disease associated with antiphospholipid syndrome.
PMID: 18366270 Feb 2008

Crohn's disease and celiac disease: association or epiphenomenon?
PMID: 16875046 June 2006

Heart Disease
See Heart Disease

Kidney Disease
See Kidney Disease

Liver Disease
See Liver Disease

Lupus (SLE)

Conclusion Only IgA-EmA was significantly associated with lupus and with the presence of discoid lesions. Until now, no obvious association with celiac disease has been found.

Spectrum of autoantibodies for gastrointestinal autoimmune diseases in systemic lupus erythematosus patients.
PMID:24057059  Sep 2013

The association of dermatitis herpetiformis and systemic lupus erythematosus.
PMID: 20739096  Aug 2010

Both myopathy patients had high levels of gliadin autoreactivity in serum and one patient had an overall autoantibody profile with lupus-like features. The findings suggest that some disorders of muscle that are considered non-autoimmune, may in fact have autoimmune features. Further examination of the role of subclinical gluten autoreactivity in the pathogenesis of myopathy syndromes has the potential to suggest improved approaches to diagnosis and treatment of these conditions.
Autoantibody profiles in two patients with non-autoimmune muscle disease implicate a role for gliadin autoreactivity. 
PMID: 20110170  March 2010

Systemic lupus erythematosus, celiac disease and antiphospholipid antibody syndrome: a rare association.
Gupta D, Mirza N.
Rheumatol Int. 2008 Sep;28(11):1179-80. Epub 2008 May 17.
PMID: 18488229

Adult celiac disease followed by onset of systemic lupus erythematosus.
Freeman HJ.
J Clin Gastroenterol. 2008 Mar;42(3):252-5.
PMID: 18223501

Coeliac disease in systemic lupus erythematosus: a case report.
Hrycek A, Siekiera U.
Rheumatol Int. 2008 Mar;28(5):491-3. Epub 2007 Oct 9.
PMID: 17924114

Celiac disease in a patient with systemic lupus erythematosus: a case report and review of literature.
PMID: 16804737 May 2007

Gluten sensitivity masquerading as systemic lupus erythematosus
PMID: 15479903 Nov 2004

Association of systemic lupus erythematosus and gluten enteropathy.
PMID: 7777890  June 1995

Gluten-sensitive enteropathy and systemic lupus erythematosus.
PMID: 3260095  July 1988

Twenty-nine (9.5%) patients with DH and 73 (19.1%) with CD had concomitant endocrine or connective tissue disorders. The following associations were found: auto-immune thyroid disease (4.3% of DH patients and 6.0% of CD patients), insulin dependent diabetes (1.0% DH and 5.5% CD), lupus erythematosus (1.3% DH and 0.3% CD), Sjogren's syndrome (1.0% DH and 2.9% CD), sarcoidosis (1.3% DH and 1.8% CD), and vitiligo or alopecia areata (1.6% DH and 0% CD).
Diseases associated with dermatitis herpetiformis. PMID: 9115907


Lymphocytic Colitis

Although most cases of lymphocytic colitis are idiopathic, there is a clear association with multiple drugs, celiac disease, and there may be an infectious trigger. Approximately 10% of lymphocytic colitis patients have a positive family history of some type of inflammatory intestinal disease, including ulcerative colitis, Crohn's disease, collagenous colitis, and celiac disease. Therapy in lymphocytic colitis is less well studied, but the same medications are used with success, including budesonide and high dose bismuth.
Collagenous and lymphocytic colitis.
PMID: 16939057 Nov 2005

Seventy nine (40%) patients reported associated diseases, of which thyroid disorders, coeliac disease, and diabetes mellitus were the most common.
Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients. Full Text
PMID: 15016748

If there is no abatement of symptoms, rule out other etiologies of diarrhea such as thyroid dysfunction, celiac disease, or bacterial overgrowth.
Lymphocytic and Collagenous Colitis. PMID: 11097741

A shared set of predisposing HLA-DQ genes account for the epidemiological overlap of celiac sprue and microscopic colitis.Although further studies will be necessary to determine if this enteropathy is induced by dietary gluten, we speculate that the small intestinal but not colonic histopathology in patients with microscopic colitis is caused by immunological gluten sensitivity.
High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome.
PMID: 10950045

Symptomatic remission was induced with a gluten/lactose-free diet, oral prednisone, and sulfasalazine and has been maintained with gluten restriction alone. We propose that, in this instance, collagenous enterocolitis represented a diffuse manifestation of gluten sensitivity.
Collagenous enterocolitis: a manifestation of gluten-sensitive enteropathy
PMID: 1500661


Lymphocytic Gastritis

Lymphocytic gastritis (LG) is defined by the recognition of >25 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells. Approximately 50% of children with celiac disease (CD) present LG, which mainly involves the gastric antrum and disappears after a gluten-free diet.

Lymphocytic gastritis in pediatric celiac disease - immunohistochemical study of the intraepithelial lymphocytic component.
PMID: 14704635

There is a high prevalence of lymphocytic gastritis in untreated celiac disease associated with elevated gastric permeability. Celiac disease seems to be a general disorder of the gastrointestinal tract associated with disturbed permeability.
Lymphocytic gastritis and gastric permeability in patients with celiac disease.
PMID: 8698227

Lymphocytic gastritis is a distinctive pattern of inflammation that resembles that seen in celiac disease and lymphocytic colitis.
Emerging gastritides. PMID: 11696291

Some studies report the lymphocytic gastritis in almost 45% of cases of sprue, with the gastritis regressing in response to a gluten-free diet, while others report a correlation of lymphocytic gastritis with serologically and/or histologically confirmed H. pylori infection, with the lymphocytic gastritis being cured by H. pylori eradication treatment in a high percentage of the cases.
Lymphocytic gastritis--a rare disorder of the gastric mucosa.
PMID: 11225446

Lymphocytic gastritis occurred in 10% of patients with coeliac disease.
Lymphocytic gastritis and coeliac disease: evidence of a positive association. Full text
PMID: 9659261

The pattern of involvement of gastric mucosa in lymphocytic gastritis is closely related to the associated duodenal pathology.
The pattern of involvement of the gastric mucosa in lymphocytic gastritis is predictive of the presence of duodenal pathology. Full text
PMID: 10690170

This is a type of chronic gastritis with dense infiltration of the surface and foveolar epithelium by T lymphocytes, and associated chronic infiltrates are in the lamina propria. Because of similar histopathology relative to celiac disease, lymphocytic gastritis has been proposed to result from intraluminal antigens. High anti?H pylori antibody titers have been found in patients with lymphocytic gastritis, and, in limited studies, the inflammation disappeared after H pylori eradication. However, many patients with lymphocytic gastritis are serologically negative for H pylori. A number of cases may develop secondary to intolerance to gluten and drugs such as ticlopidine.
Lymphocytic gastritis

Meniere's Disease

We report the case of a 63-year-old female with definite unilateral Ménière disease, osteoarthritis of the distal finger joints with mucous cysts and Heberden's nodes, and constipation with recurrent abdominal pain whose symptoms remitted after 6months of a restrictive gluten-free diet.

Ménière disease and gluten sensitivity: recovery after a gluten-free diet.
PMID:23374485  Aug 2013

RESULTS: A total of 33 MD patients (56.9%) proved to be sensitive to gliadin, eight of whom were positive to prick test after 20 minutes, 13 after 6 hours, 11 after 12 hours, and one after 24 hours. CONCLUSIONS: This is the first report of gliadin skin test response in MD. Further studies are needed to define the relationship between immune response to wheat proteins and MD symptoms.
Gluten sensitivity in Meniere's disease.

PMID 22253033  Mar 2012

Metabolic Syndrome

Adult celiac disease (CD) presents with very diverse symptoms that are clearly different from those typically seen in pediatric patients, including ferropenic anemia, dyspepsia, endocrine alterations and elevated transaminase concentration. We present the case of a 51-year-old overweight woman with altered basal blood glucose, hypercholesterolemia, hypertriglyceridemia and persisting elevated transaminase levels, who showed all the symptoms for a diagnosis of metabolic syndrome. Because she presented iron deficiency anemia, she was referred to the gastroenterology department and subsequently diagnosed with celiac disease after duodenal biopsies and detection of a compatible HLA haplotype. Gluten-free diet (GFD) was prescribed and after 6 mo the patient showed resolution of laboratory abnormalities (including recovering anemia and iron reserves, normalization of altered lipid and liver function parameters and decrease of glucose blood levels). No changes in weight or waist circumference were observed and no significant changes in diet were documented apart from the GFD. The present case study is the first reported description of an association between CD and metabolic syndrome, and invites investigation of the metabolic changes induced by gluten in celiac patients.
Resolution of metabolic syndrome after following a gluten free diet in an adult woman diagnosed with celiac disease.

PMID:21860836 June 2011

Microscopic Colitis

CONCLUSIONS:: MC is more common in patients with CD than in the general population. Patients with CD and MC have severe villous atrophy and frequently require steroids or immunosuppressant therapies to control symptoms.An Association Between Microscopic Colitis and Celiac Disease.
PMID: 19631283  July 2009

CONCLUSION: This is the largest group of patients with MC known to the authors that has been studied to date. Conditions such as celiac disease, IBS, and thyroid diseases were found to be related to MC. Furthermore, neither an increased risk of colorectal cancer nor IBD was associated with MC in this study.
Microscopic colitis: a large retrospective analysis from a health maintenance organization experience.
PMID: 19575491   July 2009



We present the clinical scenario of acute abdominal pain in a 27-year-old man with recent-onset type 1 diabetes mellitus. Evaluation of the patient revealed elevated levels of serum amylase, lipase, and transaminase without any biliary obstruction. He had elevated serum IgG4 levels, and his computed tomography scan showed features consistent with autoimmune pancreatitis. Further evaluation revealed celiac disease. He was treated as a patient with autoimmune pancreatitis and was started on steroids in addition to a gluten-free diet. His liver function improved in 6 weeks. He gained weight and his glycemic control also improved. Magnetic resonance cholangiopancreatography after 3 months revealed complete resolution of pancreatic enlargement. The patient is being followed up in our clinic since the past 3 years. To the best of our knowledge and according to the Medline search, this is the first case report of celiac disease as an association of autoimmune pancreatitis.
Celiac disease and autoimmune pancreatitis: an uncommon association. A case report.
PMID 21946127  Nov 2011


Coeliac disease-associated antibodies correlate with psoriasis activity
PMID: 15491433 Oct 2004

High prevalence of celiac disease in psoriasis.
PMID: 14638373  Nov  2003

In the entire group of patients, as well as in those on a gluten-free diet as the only treatment, Ki67 + cells in involved dermis were highly significantly decreased after the diet.
Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer Ki67+ cells in the dermis.
PMID: 14690336  2003

The present case supports the association between CD and psoriasis and the concept that psoriasis in CD patients can be improved by GFD
Rapid Regression of Psoriasis in a Coeliac Patient after Gluten-Free Diet. A Case Report and Review of the Literature. PMID: 12949434  2003

Patients with PsoA have an increased prevalence of raised serum IgA AGA and of coeliac disease. Patients with raised IgA AGA seem to have more pronounced inflammation than those with a low IgA AGA concentration.
Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet.  Full text 
PMID: 10651693  Jan 2002

Thirty of the 33 patients with AGA completed the GFD period, after which they showed a highly significant decrease in mean PASI. This included a significant decrease in the 16 AGA-positive patients with normal routine histology in duodenal biopsy specimens
Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet.
PMID: 10651693  Jan 2000

It was recently observed that in six patients with psoriasis and one with palmoplantar pustulosis, with newly discovered gluten intolerance, a gluten-free diet had a remarkable effect on the skin lesions.
Patients with psoriasis often have increased serum levels of IgA antibodies to gliadin.
PMID: 8286249  Dec 1993


Rheumatoid arthritis / arthralgias

"The aim of our case-report was to show that migratory arthralgias can be an extraintestinal manifestation of gluten-sensitive enteropathy."
[Gluten-sensitive enteropathy: a disease to take into consideration - a case report].
PMID:24003682  2013

Conclusions:  tTG antibodies may be used as a screening test to identify asymptomatic CD associated with juvenile rheumatic diseases, especially those with active JRA or marked reduction in BMI.
Asymptomatic celiac sprue in juvenile rheumatic diseases children.
PMID 22212536  Oct 2011

A 42-year-old woman presented with a 3-week history of left knee pain and swelling. She had suffered dermatitis herpetiformis for 12 years, proved by skin biopsy. She had never been on gluten-free diet. Knee pain increased with motion and her gait was antalgic. On admission, she was mainly dependent on wheelchair due to pain and limitation. Treatment plan consisted of gluten-free diet, stretching and strengthening exercises, analgesic or nonsteroidal anti-inflammatory drugs when needed. She responded well to gluten-free diet. Association of joint involvement and dermatitis herpetiformis is more than just coincidental. Possible immunopathogenesis and role of gluten-free diet on arthritis treatment are discussed.
Celiac disease of the joint.
PMID: 21152920  Dec 2010

Conclusions. Although AGA positivity is of clinical relevance only in a subset of elderly people, it seems to be related to rheumatoid arthritis and depression, both conditions linked to celiac disease. Further studies are needed to reveal the mechanisms underlying this. The poor specificity of AGA for celiac disease was here once more in evidence.  
Positive serum antigliadin antibodies without celiac disease in the elderly population: does it matter?
PMID: 20545470 June 2010

Autoimmune enteropathy and rheumatoid arthritis: a new association in the field of autoimmunity. 
PMID: 16920048   Dec 2006

A gut feeling for joint inflammation - using coeliac disease to understand rheumatoid arthritis.
PMID: 16530013  April 2006

Thyroid function, autoimmune thyroiditis and coeliac disease in juvenile idiopathic arthritis.
PMID: 15695302  Feb 2005

In this review, evidence is examined in relation to those factors which naturopaths believe are significant contributors to rheumatoid arthritis, and are hence the main focus of therapeutic management. These factors include food allergy, increased gut permeability, increased circulating immune complexes, excessive inflammatory processes, and increased oxidative stress. Naturopathic treatment attempts to alleviate symptoms by altering these factors through dietary modification, manipulation of dietary fats, and use of antioxidants and proteolytic enzymes.
Naturopathic management of rheumatoid arthritis.
PMID: 17029041 April 2005

A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens.
PMID: 11600749  2001  

As the treatment of CD-associated arthritis is based on dietary therapy, physicians should be alert to the possibility of occult CD in any child with arthritis of unclear origin.
Recurrent monoarthritis in an 11-year-old boy with occult coeliac disease. Successful and stable remission after gluten-free diet.
PMID: 10464568  1999

Despite the increased AGA positivity found distinctively in patients with recent-onset RA, none of the RA patients showed clear evidence of coeliac disease. AGA positivity in early RA may indicate a role of the gut immune system in the initiation of RA. [non-celiac gluten sensitivity? jcc]
Gliadin immune reactivity in patients with rheumatoid arthritis.

PMID: 8575138 1995

This study sought to determine whether patients with rheumatoid arthritis (RA) were immunologically sensitised to dietary protein (DP). Using an enzyme linked immunosorbent assay (ELISA), antibodies to milk and wheat proteins were measured in 93 unselected out-patients with classical or definite RA. Of these 93, 53 had raised levels of IgG antibodies to one or both dietary proteins (DP). In the DP antibody positive group, 48 patients (90%) also had raised levels of IgA rheumatoid factor (measured by ELISA) while only 7 (17%) of the 40 DP antibody negative patients had detectable IgA RF; P less than 0.02. There was no association between IgM rheumatoid factor and dietary protein antibodies. These results demonstrate that in RA, raised levels of IgA RF are associated with an increased IgG response to antigens which enter the body through the gastrointestinal tract. A breakdown in gastrointestinal tolerance to dietary antigens may play a role in the immunopathogenesis of RA in these patients who might therefore benefit from dietary manipulation.
IgA rheumatoid factor and IgG dietary protein antibodies are associated in rheumatoid arthritis. 
PMID: 2767736  July 1989

93 patients with rheumatoid arthritis (RA) were examined for histological or other evidence of gut abnormalities. 44 had raised levels of IgG to gliadin, and of these 38 (86%) were also positive for IgA rheumatoid factor (RF). 24 patients (15 with raised levels of IgA RF and wheat protein IgG [AB+] and 9 with normal levels of both antibodies [AB-]) underwent jejunal biopsy. 6 of the AB+ and 1 of the AB- patients had villous atrophy. The AB+ group had lower villous surface/volume ratio and small intestinal lactase concentrations than did the AB- group or age-matched controls. There was no significant difference between the two groups of RA patients in disease severity or treatment regimen. The findings suggest that the gut may play a more important part in the immunopathogenesis of some cases of RA than in others, and that the former may be identified by raised levels of IgA RF and wheat protein IgG.
Association between villous atrophy in rheumatoid arthritis and a rheumatoid factor and gliadin-specific IgG.
PMID: 2902267  Oct 1988

On rheumatoid arthritis and diet


[Celiac disease associated with sarcoidosis.]
PMID: 19349129  April 2009 

CONCLUSION: Immune characteristics of CD may be linked to an increased risk of sarcoidosis.
PMID: 18496982  Sept 2007

Conclusions In this cohort of patients with celiac disease, there was a significantly increased risk of sarcoidosis when compared with the American white population. This further strengthens prior associations that have been made suggesting a shared mechanism behind the etiologies of celiac disease and sarcoidosis.
Sarcoidosis in Patients with Celiac Disease.
PMID: 17934825  Oct 2007

We have demonstrated a high frequency of gastric autoimmunity and gluten-associated immune reactivity in patients with sarcoidosis, occurring in almost 40% of the cases, the former being the most frequent gastrointestinal immune manifestation.
Evidence of gastrointestinal immune reactivity in patients with sarcoidosis.
PMID: 10363754

These findings suggest that in patients with sarcoidosis, there is an altered gastrointestinal mucosal immune response, accompanied in about 40% of patients by specific sensitisation to wheat protein.
Altered gastrointestinal immune response in sarcoidosis
PMID: 3265402

Sjogren's Syndrome

Abstract Background: Premature ovarian failure is diagnosed with a picture of amenorrhea, elevated follicle-stimulating hormone (FSH), and age under 40 years. Twenty percent (20%) of patients with premature ovarian failure have a concomitant autoimmune disease. Cases of premature ovarian failure associated with Sjögren syndrome have been reported in the literature. Patient and method: We report a case of a 42-year-old white woman with Sjögren syndrome and premature ovarian failure who underwent a reversal of her premature ovarian failure and restoration of normal menses using an elimination diet protocol. The patient was diagnosed with her rheumatological condition in 2005 and started on disease-modifying antirheumatoid drugs, which were taken intermittently due to a concern over medication side-effects. Her menses became irregular at the time of initial diagnosis and finally ceased in 2006, with a dramatic elevation in her FSH, indicative of autoimmune-induced premature ovarian failure. In March 2009, she commenced an elimination diet protocol, eliminating gluten, beef, eggs, dairy products, nightshade vegetables, refined sugars, and citrus fruit for 4 months. Results: Her repeat laboratory tests after 4 months showed a drop in FSH from 88 to 6.5 and a drop in erythrocyte sedimentation rate from 40 to 16. Her menses also resumed and her rheumatological symptoms significantly improved. Conclusions: It is hypothesized that the restoration of normal menses was caused by reduced inflammation in the ovarian tissue and supports the hypothesis that the gut immune system can influence autoimmune disease and inflammation.
Reversal of premature ovarian failure in a patient with sjögren syndrome using an elimination diet protocol..
PMID: 20618099  July 2010

Gluten sensitivity in patients with primary Sjögren's syndrome.
PMID: 17613926  Aug 2007

Antibodies to gliadin, gluten and reticulin glycoprotein in rheumatic diseases: elevated levels in Sjogren's syndrome.
PMID: 6378463

Oral findings in coeliac disease and Sjogren's syndrome.
PMID: 15533207 Nov 2004

Coeliac disease in Sjogren's syndrome--a study of 111 Hungarian patients.
PMID: 13680146 Sep 2004


Systemic Sclerosis
High Incidence of Celiac Disease in Patients with Systemic Sclerosis.
PMID: 19332639  Mar 2009


Thrombocytopenic Purpura
Thrombocytopenic Purpura and Celiac Disease by Ron Hoggan 

Anemia and severe thrombocytopenia in celiac disease]
PMID: 20455043 April 2010

Conclusions. We found a positive association between CD and both ITP of any type and chronic ITP, irrespective of which disease came first, and suggest there should be increased awareness of CD in patients with ITP.
Increased risk of immune thrombocytopenic purpura among inpatients with coeliac disease.
PMID: 18365906  2008

Inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura.
PMID: 12940332 July 2003

Thrombocytopenic purpura and coeliac disease.
PMID: 3201985 Sep 1988

Celiac sprue, idiopathic thrombocytopenic purpura, and hepatic granulomatous disease. An autoimmune linkage?
PMID: 8899505 Oct 1996

Three cases of adult coeliac disease with severe vitamin B12 deficiency not accompanied by folate or iron depletion are presented. Two of the patients had the extremely rare combination of coeliac disease and lack of intrinsic factor and autoimmune thrombocytopenic purpura
Selective vitamin B12 malabsorption in adult coeliac disease. Report on three cases with associated autoimmune diseases.
PMID: 3247590 Nov 1988

Ulcerative Colitis

CONCLUSIONS:Similar to other autoimmune diseases such as celiac disease, rheumatoid arthritis, type 1 diabetes, Graves' disease, and psoriatic arthritis, genetic variation in the chromosome 4q27 region predisposes to UC, suggesting a common genetic background for these diseases
Novel Genetic Risk Markers for Ulcerative Colitis in the IL2/IL21 Region Are in Epistasis With IL23R and Suggest a Common Genetic Background for Ulcerative Colitis and Celiac Disease.
PMID: 19455118  May 2009


Repigmentation of vitiligo lesions in a child with celiac disease after a gluten-free diet.
PMID:21504457  Mar 2011