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  • Clinical Research Article
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Celiac disease is more prevalent among children and adolescents with systemic lupus erythematosus

Pediatric Research (2025)Cite this article

Abstract

Background

To investigate the prevalence of Celiac disease (CeD) in children and adolescents with SLE.

Methods

We completed a retrospective cohort study of children and adolescents with childhood-onset SLE (cSLE). We included patients who underwent CeD screening with tissue transglutaminase immunoglobulin A (tTG-IgA) serology within a year of cSLE diagnosis. Clinical and laboratory data were extracted from a dedicated lupus database, supplemented by chart review. CeD diagnosis was confirmed by duodenal histology. We calculated the prevalence of positive CeD serology, biopsy-confirmed CeD and CeD clinical features, and compared SLE features between CeD and non-CeD patients with Fisher’s exact tests.

Results

Three hundred children with SLE underwent CeD screening. Thirteen (4%) had positive tTG-IgA serology. Of those, ten (77%) underwent endoscopy and eight had histopathologic evidence of CeD (3% of cSLE cohort). Among patients with biopsy confirmed CeD, only 50% had gastrointestinal symptoms. There was no difference in prevalence of cSLE features between those with and without CeD.

Conclusion

Biopsy-confirmed CeD was three times prevalent in children and adolescents with cSLE than reported in the general pediatric population. Only half of cSLE patients with CeD had gastrointestinal symptoms, highlighting the importance of screening in the cSLE population.

Impact

  • The incidence of celiac disease has increased over the past decades, particularly in people with comorbid autoimmune diseases.

  • Celiac disease is three times more prevalent among children with systemic lupus erythematosus compared to the general pediatric population.

  • Half of childhood-onset SLE patients with biopsy confirmed celiac disease were asymptomatic, highlighting the importance of routine CeD screening in the cSLE population.

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Data availability

The datasets generated during and analyzed during this study are available from the corresponding author on reasonable request.

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Author contributors:

Oscar Mwizerwa, conceptualized and designed the study, collected data, drafted the initial manuscript, and critically reviewed and revised the manuscript. Andrea M. Knight, Deborah M. Levy and Holly Convery critically reviewed and revised the manuscript. Daniela Dominguez and Kendal Thompson collected data, critically reviewed and revised the manuscript. Nicholas Gold carried out data analysis and critically reviewed and revised the manuscript. Catharine M. Walsh critically reviewed and revised the manuscript for important intellectual content. Linda T. Hiraki conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content.

Author information

Authors and Affiliations

  1. Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada

    Oscar Mwizerwa, Andrea M. Knight, Daniela Dominguez, Deborah Levy, Holly Convery, Kendal Thompson & Linda T. Hiraki

  2. Genetics & Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada

    Daniela Dominguez, Nicholas Gold & Linda T. Hiraki

  3. Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada

    Catharine M. Walsh

Authors
  1. Oscar Mwizerwa
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Corresponding author

Correspondence to Linda T. Hiraki.

Ethics declarations

Ethical approval

This study was approved by the institution Research Ethics Board (REB number: 1000079489). As participants were enrolled in other studies (i.e. either Lupus Biorepository and/or The 1000 Canadian Faces of Lupus Studies), a waiver of consent has been approved by Hospital REB for the chart review of the larger cohort. Consent was obtained only from participants with biopsy-confirmed CeD and who were still active patients in the Lupus clinic.

Competing interests

The authors declare no competing interests. L.T.H. holds a Canada Research Chair (Tier 2) in Genetics of Rare Systemic Inflammatory Diseases, and research is supported by Childhood Arthritis and Rheumatology Research Alliance (CARRA), Lupus Research Alliance (LRA), U.S. Department of Defense, Lupus Foundation of America, Gary Hurvitz Centre for Brain & Mental Health Catalyst Grant. A.M.K. is supported by a Canada Research Chair (Tier 2) in Mental Health and Chronic Disease of Childhood, and Lupus Research Alliance Career Development Award.

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Mwizerwa, O., Knight, A.M., Dominguez, D. et al. Celiac disease is more prevalent among children and adolescents with systemic lupus erythematosus. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04491-2

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  • DOI: https://doi.org/10.1038/s41390-025-04491-2

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