A disease to consider in the differential diagnosis of lower back pain: Celiac disease and related autoimmune disorders

INTRODUCTION: Celiac disease (CD) is an autoimmune disease caused by gluten ingestion in genetically susceptible individuals. Although gastrointestinal system symptoms are common, extraintestinal symptoms may be seen during the disease course. Due to similar genetic features and pathogenetic pathways for autoimmunity, increasing rheumatological diseases have been reported in CD in recent years. In this study, we aimed to evaluate patients with CD in terms of musculoskeletal symptomatology and presence of rheumatic disease and autoantibody positivity.
METHODS: The study was designed as a cross-sectional, retrospective cohort study. Between January 2020-2022, 65 patients with CD who were followed-up in the gastroenterology clinic of our hospital and consulted to the rheumatology outpatient clinic for any reason were included in the study. Medical records were reviewed, laboratory and imaging results were recorded.
RESULTS: Admission to the rheumatology clinic, the most common symptoms were inflammatory back pain(IBP) (43.1%) followed by xerophthalmia (15.4%). None of the patients with IBP had radiographically active sacroiliitis. In total, concomitant rheumatological diseases were 6 (9.2%): 2 patients (3.1%) had Sjögren’s syndrome and one undifferentiated connective tissue disease, systemic lupus erythematosus, psoriatic arthritis and familial Mediterranean fever. Except for the CD autoantibodies, the frequency of anti-nuclear antibodies (ANA) was 38%, and the most common extractable nuclear antigen (ENA) patterns were DFS-70 and SSA.
DISCUSSION AND CONCLUSION: Although the most common symptom is IBP, the absence of radiographic findings of spondyloarthritis in CD patients suggests these to be a non-rheumatological cause associated with CD. On the other hand, CD patients with xerophthalmia and/or ANA positivity may need to be evaluated for connective tissue diseases, especially SjS.