Celiac Disease Three Times More Common in Children with Lupus, Study Reveals
Canada: A recent study published in Pediatric Research has revealed that celiac disease (CeD) occurs far more frequently among children and adolescents with systemic lupus erythematosus (SLE) than in the general pediatric population. The findings emphasize the need for routine screening of celiac disease in young patients diagnosed with lupus, even in the absence of gastrointestinal symptoms.
Dr. Linda T. Hiraki and colleagues from the Genetics & Genome Biology Department at the Research Institute, The Hospital for Sick Children, Toronto, and colleagues conducted a retrospective cohort study involving 300 children diagnosed with childhood-onset systemic lupus erythematosus (cSLE). All participants underwent screening for celiac disease using tissue transglutaminase immunoglobulin A (tTG-IgA) tests within a year of their lupus diagnosis. Clinical details and laboratory data were obtained from a specialized lupus database and verified through chart reviews. Cases of celiac disease were confirmed by duodenal biopsy, which remains the gold standard for diagnosis.
The key findings of the study were as follows:
- Out of 300 children screened, 13 (4%) tested positive for tTG-IgA antibodies, a key marker of celiac disease.
- Among those with positive serology, 10 underwent endoscopy, and 8 had biopsy-confirmed celiac disease.
- The prevalence of biopsy-confirmed celiac disease in children with lupus was 3%, nearly three times higher than in the general pediatric population.
- Only half of the children with confirmed celiac disease experienced gastrointestinal symptoms such as abdominal pain, bloating, or diarrhea.
- The remaining patients were asymptomatic, indicating that depending solely on symptoms could result in missed diagnoses.
- No significant differences were observed in lupus-related features or laboratory findings between children with and without celiac disease.
- These results suggest that celiac disease can exist silently in children with systemic lupus erythematosus without affecting the typical course of the illness.
Dr. Hiraki and her team emphasized that the findings highlight the growing prevalence of celiac disease, particularly in individuals with autoimmune conditions. Since both SLE and CeD share immune dysregulation as an underlying mechanism, their coexistence may reflect a common genetic or immunologic predisposition.
The study further noted that the rising global incidence of celiac disease over recent decades, coupled with its frequent occurrence in patients with other autoimmune disorders, supports the need for proactive screening strategies. Early identification of celiac disease allows for dietary management through gluten-free nutrition, which can prevent long-term complications and improve overall health outcomes in children living with SLE.
The researchers reported that celiac disease is three times more prevalent among children and adolescents with systemic lupus erythematosus compared to their healthy peers. Since half of these cases present without gastrointestinal symptoms, routine celiac disease screening should be considered for all pediatric lupus patients to ensure timely diagnosis and optimal disease management.
Reference:
Mwizerwa, O., Knight, A. M., Dominguez, D., Levy, D., Convery, H., Thompson, K., Gold, N., Walsh, C. M., & Hiraki, L. T. (2025). Celiac disease is more prevalent among children and adolescents with systemic lupus erythematosus. Pediatric Research, 1-4. https://doi.org/10.1038/s41390-025-04491-2
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