Several case reports indicate a link between coeliac disease (CD) and sarcoidosis. Our main objective was to investigate the risk of subsequent sarcoidosis in individuals with CD in a general population cohort study. A second aim was to estimate the risk of CD in individuals with prior sarcoidosis.
We used Cox proportional hazards method to calculate the risk of subsequent sarcoidosis in 14,349 individuals who had received a diagnosis of CD (1964-2003) and 69,998 age- and sex-matched individuals without a diagnosis of CD. Subjects were identified through the Swedish national Inpatient Register. Conditional logistic regression was used to study the risk of CD associated with prior sarcoidosis.
CD was associated with an increased risk of sarcoidosis (Hazard ratio (HR) = 4.03; 95% CI = 2.32-7.00; p < 0.001), and was not notably affected by adjustment for socioeconomic index. In individuals with CD listed as the main diagnosis, the HR was 3.66 (95% CI HR = 1.80-7.45; p < 0.001). Prior sarcoidosis was associated with an increased risk of CD (Odds ratio = 3.58; 95% CI = 1.98-6.45; p < 0.001).
Immune characteristics of CD may be linked to an increased risk of sarcoidosis.
"Twenty percent of IBM patients had positive autoantibodies in another series, including: ANA, anti-SSA/Ro, anti-SSb/La, antiribonucleoproteins (RNP), anti-Sm, anticardiolipin (ACA), anti-GM1, and rheumatoid factor (RF) . Similarly, sarcoidosis has been associated with autoimmune diseases such as autoimmune thyroid disease , psoriasis , and celiac disease . It is unclear in these patients whether sarcoidosis or IBM was the primary disease, but interestingly they do share common immune pathways of disease. "
[Show abstract][Hide abstract] ABSTRACT: Inclusion body myositis (IBM) is a slowly progressive inflammatory myopathy characterized by selective weakness of finger flexors and quadriceps muscles commonly refractory to treatment. Another chronic inflammatory disorder, sarcoidosis, commonly involves muscle. The comorbidity of inclusion body myositis and sarcoid myopathy is rare. We describe clinical and muscle biopsy findings of a patient with sarcoidosis and inclusion body myositis. A 66-year-old man presented with a 6-year history of progressive,asymmetrical and selective weakness of the quadriceps, biceps and finger flexor muscles; he had a remote history of pulmonary sarcoidosis. A quadriceps muscle biopsy revealed a chronic inflammatory myopathy with ubiquitinated inclusion bodies, rimmed vacuoles, expression of major histocompatibility complexclass I, numerous COX-negative fibers and TDP-43 cytoplasmic aggregates (features of IBM) and multiple non-necrotizing granulomata (feature of sarcoidosis). Clinical and histopathologic features of the current illness suggested the patient had sarcoidosis with inclusion body myositis overlap. This patient may represent the coincidental occurrence of both idiopathic inflammatory disorders. Alternatively, sarcoidoisis may promote the development of inclusion body myositis by a similar immune-mediated pathophysiologic process.
[Show abstract][Hide abstract] ABSTRACT: Celiac disease (CD) is frequently accompanied by a variety of extradigestive manifestations, thus making it a systemic disease rather than a disease limited to the gastrointestinal tract. This is primarily explained by the fact that CD belongs to the group of autoimmune diseases. The only one with a known etiology is related to a permanent intolerance to gluten. Remarkable breakthroughs have been achieved in the last decades, due to a greater interest in the diagnosis of atypical and asymptomatic patients, which are more frequent in adults. The known presence of several associated diseases provides guidance in the search of oligosymptomatic cases as well as studies performed in relatives of patients with CD. The causes for the onset and manifestation of associated diseases are diverse; some share a similar genetic base, like type 1 diabetes mellitus (T1D); others share pathogenic mechanisms, and yet, others are of unknown nature. General practitioners and other specialists must remember that CD may debut with extraintestinal manifestations, and associated illnesses may appear both at the time of diagnosis and throughout the evolution of the disease. The implementation of a gluten-free diet (GFD) improves the overall clinical course and influences the evolution of the associated diseases. In some cases, such as iron deficiency anemia, the GFD contributes to its disappearance. In other disorders, like T1D, this allows a better control of the disease. In several other complications and/or associated diseases, an adequate adherence to a GFD may slow down their evolution, especially if implemented during an early stage.
[Show abstract][Hide abstract] ABSTRACT: Chronic pediatric diseases arising from early-life immune insult and postnatal immune dysfunction are among the most prevalent health challenges for children. Diseases such as childhood asthma and allergies, chronic otitis media, type 1 diabetes, childhood leukemia and pediatric celiac disease all feature dysfunctional immune responses and/or inappropriately skewed immune capacities. Additionally, these disorders have been increasing in incidence in recent years with previously identified risk factors unable to fully account for the change. Still, some treatment approaches target the initial health complaint and its symptoms without fully addressing either the underlying immune dysfunction of the initial disease or the likelihood for additional associated health risks in later life. Therefore, it is useful to understand both the nature of the immune dysfunction as well as the reported associated health risks. This review characterizes those pediatric immune dysfunctions produced by well-studied immunotoxicants and provides a matrix of those health risks that appear to be linked together via the underlying pediatric immune dysfunction. This information could lead to: 1) improved identification and treatment of underlying immune dysfunction, 2) long-term approaches to health management, and 3) improved prenatal and neonatal prevention strategies to avoid environmentally-induced immune insult and developmental immunotoxicity.
Current Pediatric Reviews 01/2009; 5(1):36-51. DOI:10.2174/157339609787587591
Brittany L Vieira, David J Hernandez, Charles Qin, Stephanie S Smith, John Y S Kim, Jose C Dutra
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