S1569 Gender-Based Association of Celiac Disease With Systemic Lupus Erythematosus and Other Rheumatologic Conditions: Analysis From National Inpatient Database

Abstract

Introduction: Celiac disease is an immune mediated disorder of the digestive system that often presents with extraintestinal manifestations. The association of celiac disease with dermatitis herpetiformis, Type I Diabetes, IgA deficiency and chromosomal defects like Turner’s and Down’s syndrome is well known. However, the association of rheumatological diseases with Celiac disease remains controversial, especially based on gender. The aim of our study was to examine the association of rheumatological diseases with Celiac disease, stratified by gender. Methods: All adult hospitalized patients from January 2016 to December 2019 in nationwide inpatient sample (NIS) were captured. The study population included all patients with a diagnosis of Celiac disease using ICD-10 codes (International Classification of Diseases, tenth edition). Those without Celiac disease were included as the Control group. We identified patients with a diagnosis of SLE (Systemic Lupus Erythematosus), RA (Rheumatoid Arthritis), Fibromyalgia, Polymyalgia Rheumatica (PMR), Polymyositis/Dermatomyositis (PM/DM), Sjogren syndrome and Psoriatic Arthritis (PsA) using ICD-10 codes. We used linear regression for comparing continuous variables and Chi-square test for categorical variables. The association between Celiac disease and rheumatological conditions was analyzed using multivariate logistic regression model. Results: Our study included a sample size of 122,238,462 patients, of which 158,910 (0.13%) patients had Celiac disease and 122,079,552 (99.87%) patients did not. In the study group, highest risk was seen with Sjogren in both males (aOR=7.41) and females (aOR=3.93), with P< 0.001, followed by PM/DM (aOR=4.44 in males and aOR=2.11 in females, P-value < 0.001) compared to the control group. We also noted a higher risk of Celiac with SLE (aOR=1.72), RA (aOR=1.34), Fibromyalgia (aOR= 2.09), PMR (aOR=1.65) and PsA (aOR=2.71), all with P< 0.001 (Figure, Table). Similarly in males, greater risk was seen with SLE (aOR=2.51), RA (aOR=1.34), fibromyalgia (aOR=2.59), PMR (aOR=1.52), and PsA (aOR, 2.63). Conclusion: There is a significantly greater association of Rheumatological conditions with Celiac disease, more so in males than in females. Although, more studies are warranted to determine the causal relationship, knowledge about the association between them can help with early diagnosis and better management of these patients.Figure 1.: Graph 1 Table 1. - Association of Celiac disease with Rheumatologic diseases Rheumatologic diseases Females Males Unadjusted odds ratio Adjusted odds ratioa Unadjusted odds ratio Adjusted odds ratioa SLE* 2.49b 1.72b 2.89b 2.51b Rheumatoid Arthritis 1.83b 1.34b 1.55b 1.34b Fibromyalgia 3.06b 2.09b 3.44b 2.59b Polymyalgia Rheumatica 1.65b 1.35b 1.65b 1.52b Polymyositis/dermatomyositis 2.86b 2.11b 4.51b 4.44b Psoriatic arthritis 2.71b 1.57b 3.32b 2.63b Sjogren 6.68b 3.91b 10.25b 7.37b *SLE- Systemic Lupus Erythematosus.aAdjusted for age, race, Elixhauser score and other rheumatologic conditions.bsignificant and/or P<0.001.