Prevalence of Celiac Disease in Patients With Ocular Autoimmune Disease

Abstract

Introduction: There have been recent reports about the association between celiac disease (CD) and ocular autoimmune disease (OAD), especially in Behcet’s patients. Although a moderately increased risk of OAD exists in patients with biopsy-proven CD, the prevalence of CD in OAD subjects remains unknown. Our aim was to investigate the prevalence of CD in a cohort of patients with non-infectious OAD from a tertiary uveitis center. Methods: With IRB approval and prior informed consent, we performed a cross-sectional study from 2012-2013. All patients with non-infectious OAD were included. Patients without a prior diagnosis of CD were checked for HLA-DQ2/DQ8 status, Ig A tissue transglutaminase antibody, and Ig A antiendomysial antibody, and were required to fill out a survey about gastrointestinal (GI) symptoms. Patients with a past history of infectious ocular disease were excluded. Demographics, type of ocular disease, and comorbidities were collected from each patient enrolled in the study. Results: This study included 124 patients (40 men and 84 women). Mean age was 46 years (range, 9-78 years). Most patients included were white (85%), had idiopathic uveitis (53.2%), and had anterior uveitis (40.3%). Forty-six percent of subjects were receiving immunomodulatory therapy (IMT) at the time of inclusion into the study. Four subjects had been diagnosed with CD by confirmatory biopsy prior to inclusion in our study. These patients did not fill out the survey and were not tested for CD autoantibodies. Out of 120 subjects tested serologically, 5 had positive serology for CD autoimmunity. Four of those subjects were HLA-DQ2-positive, and 1 subject was both HLA-DQ2 and DQ8-positive. From those with positive CD autoimmunity, 2 patients were biopsy-positive, 2 patients refused confirmatory biopsy, and 1 subject was biopsy-negative. Overall, 6 patients were identified as having biopsy proven-CD in our cohort of 124 patients, with a prevalence of 4.8. Although GI symptoms were very common in this series, 4 out of 5 subjects with positive serology were asymptomatic. Conclusion: Our study underlines the higher risk of CD in subjects with non-infectious OAD (around 5-fold greater prevalence in our series) compared to the general population. Identifying the presence of this association is critical because CD requires life-style modifying measures. Exclusion of gluten from the diet may help alleviate ocular symptoms without use of IMT, though further studies are needed. This study provides new epidemiological data and emphasizes the need of considering CD screening in patients with OAD without identified underlying etiology.