What autoimmune conditions most commonly occur along with celiac disease?
While there is vastly more information available now than there was even 20 years ago, autoimmune disease remains a complex and confusing phenomenon that leaves many questions unanswered. Celiac patients have a definite increased risk of developing additional autoimmune diseases, but the reason for this is incompletely understood. Thyroid disorders (both hyper- and hypothyroidism) and Type I diabetes appear to have the highest correlation, but rheumatoid arthritis, lupus, Sjögren’s syndrome, inflammatory bowel diseases and others also develop at higher rates in the celiac population than in the general population.
Research has identified some of the genes associated with autoimmunity, but there are likely many more to be found. Additionally, genetics alone does not lead to development of disease. It is thought that some type of noxious event such as illness, stress, an accident triggers the autoimmune reaction in susceptible people.
An outstanding question is whether the predisposition for celiac is also a predisposition for the other diseases, or if the inflammation and gut injury of celiac causes the development of antibodies (i.e., immune attack cells) against other body systems. Interestingly, research shows that the earlier a celiac patient removes gluten from the diet, the less likely she is to develop another autoimmune condition. This is very exciting news for celiac patients and a great motivator to stay off the gluten.
If I am managing celiac plus another autoimmune condition, how can I tell which condition is causing a flare?
Once a person has had these diseases for a while, she often starts to recognize the symptoms and knows which disease is flaring. However, once a flare occurs, it often sets off a chain reaction and the other diseases start acting up. Ideally, you can intervene early and add on the extra medications or therapies that work best. Never forget the importance of rest, healthy nutrition, gentle exercise and self-compassion.
Will the multiple conditions run in tandem (i.e., if celiac is well-managed, will symptoms of another autoimmune condition be lessened or more likely to be symptomatic)?
The little research that is available indicates that inflammation breeds inflammation – that is, if the celiac is poorly managed, then there appears to be increased rates of inflammation and flares in other autoimmune diseases. Likewise, anecdotal evidence (mainly direct patient and provider reports) support this experience.
If celiac is well-managed, will the symptoms of other diseases be lessened or are they more likely to be symptomatic and treated as separate conditions?
There’s no proven answer on this, but since we now know that controlling celiac early reduces the incidence of other autoimmune diseases, it’s a good guess that one could also help tame the other autoimmune diseases by keeping the celiac in check. That said, you shouldn’t forego recommended treatment with the hope that controlling your celiac will eliminate the other diseases completely.
Questions for your doctor:
- I’ve just been diagnosed with celiac. Should I be tested for anything else?
- Should my family members be tested?
- I’ve got other autoimmune diseases but NOT celiac – should I go gluten free anyway?
- Curr Opin Gastroenterol 22:674–679. 2006 Lippincott Williams & Wilkins.
- Digestive Diseases and Sciences, February 2000; 45: 403-406.
About the Author
Kathi Kuntz, RN, MSN holds a Bachelor’s and a Master’s Degree in Nursing from the University of Pennsylvania. Her specialization is in the healthcare of women and her graduate research thesis was on autoimmune disease in pregnancy. She has over ten years of clinical practice experience. Currently, Kathi is on an adventure living and traveling with her husband and two young sons in Australia.