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Objective. To investigate a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE). Case series have indicated a possible association, but population-based studies are lacking.
Methods. We compared the risk of SLE in 29,048 individuals with biopsy-verified CD (villous atrophy, Marsh 3) from Sweden’s 28 pathology departments with that in 144,352 matched individuals from the general population identified through the Swedish Total Population Register. SLE was defined as having at least 2 records of SLE in the Swedish Patient Register. We used Cox regression to estimate hazard ratios (HR) for SLE.
Results. During followup, 54 individuals with CD had an incident SLE. This corresponded to an HR of 3.49 (95% CI 2.48−4.90), with an absolute risk of 17/100,000 person-years and an excess risk of 12/100,000. Beyond 5 years of followup, the HR for SLE was 2.54 (95% CI 1.57−4.10). While SLE was predominantly female, we found similar risk estimates in men and women. When we restricted our outcome to individuals who also had a dispensation for a medication used in SLE, the HR was 2.43 (95% CI 1.22−4.87). The HR for having 2 records of SLE diagnoses, out of which at least 1 had occurred in a department of rheumatology, nephrology/dialysis, internal medicine, or pediatrics, was 2.87 (95% CI 1.97−4.17).
Conclusion. Individuals with CD were at a 3-fold increased risk of SLE compared to the general population. Although this excess risk remained more than 5 years after CD diagnosis, absolute risks were low.
Supported by grant K23 AR057815-01A1 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)/US National Institutes of Health (NIH). Dr. Ludvigsson was supported by grants from the Swedish Society of Medicine, the Swedish Research Council, the Swedish Celiac Society, and the Fulbright Commission. Dr. Murray was supported by The National Institutes of Health — DK071003 and DK057892, and by grant support from Alba Therapeutics; he is on the advisory board of Alvine Pharmaceuticals Inc. and Nexpep; he is a consultant for Ironwood Inc., Flamentera, Actogenix, Ferring Research Institute Inc., Bayer Healthcare Pharmaceuticals, Vysera Biomedical, 2G Pharma, Inc., ImmunosanT Inc., and Shire US Inc. Dr. Rubio-Tapia was supported by an American College of Gastroenterology Junior Faculty Development Award. Dr. Chowdhary was supported by a National Institute of Arthritis and Musculoskeletal Diseases — K23 AR057815-01A1, Ronald F. Kinney Executive Dean for Research Career Development Award, Mayo Foundation. Dr. Simard was supported by the Strategic Research Program in Epidemiology at Karolinska Institutet.
- Accepted for publication June 13, 2012.