Anti-transglutaminase, antigladin and ultra purified anti-gladin antibodies in patients with a diagnosis of rheumatoid arthritis

Dionisio Castillo-Ortiz, José; Durán-Barragán, Sergio; Sánchez-Ortíz, Adriana; Ramos-Remus, Cesar

doi:10.1016/S2173-5743(11)70005-3

Información del artículo

Abstract

Celiac disease (CD) is an enteric disease caused by dietary gluten in individuals with genetic predisposition. One of the clinical manifestations of CD is peripheral arthritis that may simulate RA.

Objective

To determine the frequency of anti-gliadin (aGL), anti-tissue transglutaminase (aTGT) and ultra purified anti-gliadin (AGLU) antibodies in patients with RA.

Methods

Cross-sectional study. We included consecutive patients diagnosed as RA (ACR). Demographic and clinical data were registered by direct interview and serum levels of aGL, aTGT and aGLU were determined using ELISA.

Results

Eighty-five RA patients were included; 87% were women. Mean age was 44±12 years, mean disease duration 12±9 years. IgG aGL antibodies were positive in 16 patients, IgA aGL antibodies in 29 patients, Aglu in 14 patients and only one patient had aTGT.

Conclusions

It is possible that CD may be the correct diagnosis in a patient with polyarthritis, even if the patient meets the ACR criteria for RA. In other words, CD should be considered among the differential diagnoses in a patient with polyarthritis.

Keywords:

Rheumatoid arthritis

Celiac disease

Anti-tissue transglutaminase

Anti-gliadin and ultra purified anti-gliadin antibodies

Resumen

La enfermedad celiaca (EC) es una afección entérica ocasionada por la ingesta de granos que contienen gluten. Una manifestación clínica poco reconocida es la artritis periférica, que puede simular artritis reumatoide.

Objetivo

Determinar la frecuencia de anti-Gliadina (aGL), anti Transglutaminasa Tisular (aTGT) y anti-Gliadina Ultra-purificada (aGLU) en pacientes con diagnóstico de AR.

Métodos

Es un estudio transversal de pacientes con AR (criterios ACR). Se registraron variables demográficas y clínicas y se les realizaron determinaciones séricas de anticuerpos aGL, aGLU y aTGT por ELISA.

Resultados

Se incluyeron 85 pacientes con AR. El 87% de los pacientes fueron mujeres. El promedio de edad fue de 44 años ± 12, con una media de 12±9 años de evolución. Los anticuerpos aGL IgG estuvieron positivos en 16 pacientes, los aGL IgA en 29 pacientes, la aGLU en 14 pacientes y solo un paciente fue positivo para aTGT.

Conclusiones

Es posible que pacientes con poliartritis y que cumplan con los criterios de clasificación de AR puedan tener de hecho EC. De otra forma, la EC debe considerarse dentro del diagnóstico diferencial de poliartritis.

Palabras clave:

Artritis reumatoide

Enfermedad celiaca

Anticuerpos anti-transglutaminasa tisular

Anti-gliadina y anti-Gliadina ultra-purificada

El Texto completo está disponible en PDF

References

[1.]

H.S. El-Gabalawy, P. Duray, R. Goldbach-Mansky.

Evaluating patients with arthritis of recent onset: studies in pathogenesis and prognosis.

JAMA, 284 (2000), pp. 2368-2373

Medline

[2.]

L.M. Sollid, B.A. Lie.

Celiac disease genetics: current concepts and practical applications.

Clin Gastroenterol Hepatol, 3 (2005), pp. 843-851

Medline

[3.]

J. West, R.F. Logan, P.G. Hill, A. Lloyd, S. Lewis, R. Hubbard, et al.

Seroprevalence, correlates, and characteristics of undetected celiac disease in England.

Gut, 52 (2003), pp. 960-965

Medline

[4.]

M. Mäki, K. Mustalahti, J. Kokkonen, P. Kulmala, M. Haapalahti, T. Karttunen, et al.

Prevalence of celiac disease among children in Finland.

N Engl J Med, 348 (2003), pp. 2517-2524

http://dx.doi.org/10.1056/NEJMoa021687 | Medline

[5.]

G. Tatar, R. Elsurer, H. Simsek, Y.H. Balaban, G. Hascelik, O.I. Ozcebe, et al.

Screening of tissue transglutaminase antibody in healthy blood donors for celiac disease screening in the Turkish population.

Dig Dis Sci, 49 (2004), pp. 1479-1484

Medline

[6.]

A. Fasano, I. Berti, T. Gerarduzzi, T. Not, R.B. Colletti, S. Drago, et al.

Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study.

Arch Intern Med, 163 (2003), pp. 286-292

Medline

[7.]

P.J. Bingley, A.J. Williams, A.J. Norcross, D.J. Unsworth, R.J. Lock, A.R. Ness.

Undiagnosed coeliac disease at age seven: population based prospective birth cohort study.

BMJ, 328 (2004), pp. 322-323

http://dx.doi.org/10.1136/bmj.328.7435.322 | Medline

[8.]

A. Rostom, C. Dubé, A. Cranney, N. Saloojee, R. Sy, C. Garritty, et al.

The diagnostic accuracy of serologic tests for celiac disease: a systematic review.

Gastroenterology, 128 (2005), pp. S38-46

Medline

[9.]

I.D. Hill.

What are the sensitivity and specificity of serologic tests for celiac disease? Do sensitivity and specificity vary in different populations?.

Gastroenterology, 128 (2005), pp. S25-S32

Medline

[10.]

M.J. Coenen, G. Trynka, S. Heskamp, B. Franke, C.C. Van Diemen, J. Smolonska, et al.

Common and private genetic background for rheumatoid arthritis and celiac disease.

Ann Rheum Dis, 68 (2009), pp. 182

[11.]

I. Hafström, B. Ringertz, A. Spångberg, L. Von Zweigbergk, S. Brannemark, I. Nylander, et al.

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.

Rheumatology (Oxford), 40 (2001), pp. 1175-1179

[12.]

V. Neumann, V. Wright.

Arthritis associated with bowel disease.

Clin Gastroenterol, 12 (1983), pp. 767-795

Medline

[13.]

F. Arnett, S. Edworthy, D. Bloch, D. McShane, J. Fries, N. Cooper, et al.

The American Rheumatism Association 1987 revised criteria for the classification of Rheumatoid Arthritis.

Arthritis Rheum, 31 (1988), pp. 315-324

Medline

[14.]