Swedish researchers have discovered that celiac disease may increase the risk of neuropathy.
The study, published this week in the journal JAMA Neurology, was conducted among a large group of patients with celiac disease which had been confirmed by biopsy. The large population-based group was studied in a case-controlled manner. The team, headed by Jonas Ludvigsson, MD, PhD, of Stockholm's Karolinska Institute, revealed that patients with celiac disease were 2.5 times more likely to be diagnosed with neuropathy.
"Given the autoimmune nature of celiac disease, our data reinforce the potential role of immunologic mechanisms for the development of neuropathy," Ludvigsson says.
Celiac disease occurs in patients who are genetically sensitive to gluten. It creates an enteropathy that is mediated by the immune system. Experts believe that celiac disease occurs in about 1 percent of the general population. Neurological symptoms caused by celiac disease have been noted in medical circles, but until this study there has not been any confirmation of neuropathy associated with celiac disease. Ludvigsson and his team determined the prevalence and risks to developing celiac-associated neuropathy by comparing data from 28,232 celiac patients with that of 139,473 matched controls.
The results show that while the absolute risk of neuropathy in the general population was 15 per 100,000 person-years; in contrast the rate among celiac patients was 64 per 100,000 person-years within the first year of onset. Results were controlled for alcoholic disorders, autoimmune thyroid disease, country of birth, educational level, pernicious anemia, rheumatologic diseases, socioeconomic status, type 1 and type 2 diabetes, and vitamin deficiencies. Gender was not a factor.
Surprisingly these results appear to go both ways: "There was also a bidirectional association between celiac disease and neuropathy, since patients with neuropathy were also at increased risk of future celiac disease."
However, the team admits that the bidirectional association may be the result of observer bias; after all, physicians may be more inclined to look for neuropathy in patients with celiac disease. However, because the risk of neuropathy is consistent over time-beyond five years post diagnosis, observer bias is less likely.
The team concluded that the data "may also suggest that the two diseases may share risk factors or a common underlying etiology for the development of neuropathy, such as a potential role of immunologic mechanisms. The association between celiac and different types of neuropathy suggests that there may be specific underlying mechanisms that may lead to the predominance of one type of neuropathy compared with others."
The research team indicates that patients being treated for neuropathy also receive screening for celiac disease.
"Although absolute risks for neuropathy are low, celiac is a potentially treatable condition with a young age of onset. Our findings suggest that screening could be beneficial in patients with neuropathy."
