| Popis: |
Background: Celiac Disease (CD) is an autoimmune intestinal disorder triggered by gluten exposure in genetically predisposed individuals. It is well described its association with other autoimmune diseases (AIDs), mainly type 1 diabetes mellitus (T1DM) and autoimmune thyroiditis (AT). Age and sex seem to have a role in driving the risk pattern for developing other AIDs among individuals with CD throughout life. Objectives: To study the prevalence of AIDs among pediatric and adult individuals with CD and recognize clinical parameters potentially correlated to such association. Methods: Retrospective study of medical records followed by telephone interview with individuals with CD followed at the Gastroenterology Unit of a tertiary level University hospital. Results: We assessed 328 patients, 235 (72%) females, currently aged from 2 to 74 years (yr), mean age at CD diagnosis (CD-dx) 22 yr (±15.6). From the total, 72 patients (22%) presented at least one associated AID, being 47 females (65.3%), and the CD-dx of this subgroup was 32.5 yr (±12.0). Thirty-one patients presented T1DM (43%): 16 females, mean CD-dx 9 yr (±8.5). Twenty-two patients (30.5%) presented associated AT (Graves' disease or Hashimoto's thyroiditis): 14 females (66.3%), mean CD-dx 35.2 yr (±25.5). Dermatitis herpetiformis was present in 17 patients (23.6%): 12 females (70.6%), mean CD-dx 29.8 yr (± 0.7). Systemic lupus erythematosus was present in 3 patients (4.2%), all females, mean CD-dx 37.5 yr (±7.8). Eight patients (10.8%) presented more than two associated AIDs: 4 females; mean CD-dx 20 yr (±1.4). The overall mean time between the diagnosis of CD and the second AID was 4.3 yr (±2.8). The individuals whose diagnosis of CD was in pediatric ages presented a 72% higher risk of developing a second autoimmunity (p=0.005) compared to adults. The risk of developing T1DM among male celiac patients was 76% higher than females (p=0.013), regardless of age. The risk of developing a third immunity was also 3.2 times higher in males (p=0.047). Conclusion: Although other non-celiac AIDs were more prevalent among females, males are at higher risk for developing T1DM as well as a third autoimmunity. The pediatric group showed to be more vulnerable to develop subsequent AIDs than adults. Those data strength the importance of clinical and serological screening for other AIDs among patients with CD, especially children and adolescents. |
