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IgA and IgG tissue transglutaminase antibodies in systemic lupus erythematosus

Department of Medicine ‘B’ and Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

Y Shoenfeld

Department of Medicine ‘B’ and Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel, shoenfel{at}post.tau.ac.il

N Bizzaro

Laboratorio di Patologia Clinica, Ospedale Civile, Venice, Italy

D Villalta

Servizio di Immunologia Clinica e Virologia, Pordenone, Italy

A Doria

Divisione di Reumatologia, Universitàdi Padova, Padova, Italy

E Tonutti

Istituto di Chimica Clinica, Azienda Ospedaliera "S. Maria della Misericordia", Udine, Italy

R Tozzoli

Laboratorio Analisi Chimico-cliniche e Microbiologia, Ospedale Civile, Latisana, Italy

Systemic lupus erythematosus (SLE) and coeliac disease (CD) are diseases of an autoimmune origin that share the human leukocyte HLA-B8 and HLA-DR3 histocompatibility antigens, yet the co-association of CD with SLE is mainly based on case reports. Thus, the real prevalence of CD in SLE is unclear. The aim of this study was to determine the prevalence of antitissue transglutaminase (anti-tTG) in SLE and the relation between SLE and CD. In this case-control study, 100 patients with SLE, and 120 healthy subjects were studied. Sera from all participantswere analysed for the presence of IgA and IgG anti-tTG antibodies using a human recombinant tissue transglutaminase (tTG) immuno-enzymatic assay. Anti-tTG positive patients and controls were further tested for anti-endomysial (EMA) antibodies by an indirect immunofluorescence and HLA typing (DQa1*0501- DQb1* 0201 allele determination). Subjects who had EMA or the mentioned allele, underwent duodenal biopsy to confirm a possible diagnosis of CD. Anti-tTG antibodies (IgA or IgG isotypes) were found in three of the 100 SLE patients (overall prevalence of 3%): one had the IgA and two the IgG isotypes.Only 1 of 120 healthy subjects(0.8%) had a low positivereactionfor IgA anti-tTG. Only the IgA anti-tTG positiveSLE patient was diagnosed as having CD based on a positive IgA-EMA and small bowel biopsy findings. The two IgG anti-tTG positive SLE patients and the IgA anti-tTG positive healthy subject were classified as false positives (EMA negative and HLA DQa1*0501- DQb1* 0201 allele negative). In conclusion, anti-tTG antibodies were found at a low rate in SLE patients and mostly did not indicate the presence of CD. Thus, serological screening for CD is not recommended in SLE, unless a clinical suspicion of CD is present.

Key Words: anti-endomysial antibodies • coeliac disease • systemic lupus erythematosus • tissue transglutaminase antibodies

Lupus, Vol. 13, No. 4, 241-244 (2004)
DOI: 10.1191/0961203304lu1004oa


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