Celiac Disease Found More Often in Children with Lupus

Celiac.com 12/12/2025 - New research has revealed that children and teenagers living with systemic lupus erythematosus are significantly more likely to also have celiac disease than their peers in the general population. This study, which focused on childhood-onset lupus, adds important information to our understanding of how autoimmune diseases often overlap and may influence each other.

Systemic lupus erythematosus is a chronic autoimmune condition that causes the immune system to attack the body’s own tissues, leading to inflammation and damage in organs such as the skin, kidneys, joints, and brain. Celiac disease is another autoimmune disorder in which eating gluten—a protein found in wheat, barley, and rye—triggers an immune reaction that harms the small intestine. Both diseases involve abnormal immune responses, which may explain why they sometimes appear together in the same patients.

Purpose of the Study

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The main goal of this research was to find out how common celiac disease is among children and adolescents who have lupus that begins in childhood. While earlier reports had suggested a possible connection between these two autoimmune conditions, no large studies had yet looked at how frequently they occur together in young patients. The researchers also wanted to understand whether children with lupus who have celiac disease show any unique symptoms or differences compared to lupus patients without celiac disease.

How the Study Was Conducted

This investigation was carried out as a retrospective cohort study, meaning the researchers examined existing patient data collected over time. They reviewed the medical records of children diagnosed with lupus at a pediatric lupus center. To be included in the study, each patient had to have been tested for celiac disease within one year of their lupus diagnosis.

The screening test used was called the tissue transglutaminase immunoglobulin A test, which is one of the most accurate blood tests available for identifying potential celiac disease. If the test result was positive, the patient was usually referred for an intestinal biopsy, which is considered the gold standard for confirming the diagnosis. The biopsy looks for microscopic signs of damage to the small intestine that are characteristic of celiac disease.

The researchers also gathered detailed information about each patient’s lupus symptoms, laboratory results, and clinical history. This allowed them to compare children with both diseases against those who had lupus alone, to see if there were any differences in how lupus behaved in these two groups.

Key Findings

Out of 300 children and adolescents with lupus who were screened for celiac disease, thirteen had positive blood tests. This means that about four percent of the young lupus patients showed possible signs of celiac disease through laboratory testing.

Of the thirteen who tested positive, ten went on to have an endoscopy procedure with biopsy of the small intestine. Eight of those ten—representing roughly three percent of the total group—were confirmed to have celiac disease based on intestinal tissue findings. This rate of biopsy-confirmed celiac disease was about three times higher than what is typically seen in the general population of children.

Interestingly, only half of the lupus patients who were diagnosed with celiac disease experienced noticeable digestive symptoms such as bloating, diarrhea, or stomach pain. The others had no clear intestinal complaints, which suggests that relying on symptoms alone would have missed a significant number of cases. There were no major differences in how lupus presented itself between those who had celiac disease and those who did not. In other words, having both diseases did not appear to make lupus symptoms worse or cause new types of lupus-related problems.

What the Results Mean

The fact that celiac disease was found to be three times more common in young people with lupus than in the general population provides strong evidence of a connection between these two autoimmune disorders. It is already known that people who have one autoimmune condition are more likely to develop another, but this study emphasizes the importance of paying closer attention to potential overlaps in children, not just adults.

The finding that half of the affected children showed no digestive issues is especially noteworthy. Many people still believe that celiac disease always causes obvious gastrointestinal problems, but in reality, it can also appear silently or cause symptoms that are easily mistaken for other conditions. Without testing, these cases can go undetected for years, allowing intestinal damage and nutrient deficiencies to progress.

For children with lupus, this is especially concerning because lupus itself can cause fatigue, anemia, and weight changes—symptoms that also occur in celiac disease. This overlap makes it even harder for doctors and families to recognize when a child might have both conditions. Routine testing for celiac disease in children with lupus could therefore prevent missed diagnoses and help improve long-term health outcomes.

Possible Biological Connections

Although this study was not designed to explore the biological reasons why lupus and celiac disease might occur together, the overlap likely involves shared immune system pathways. Both conditions involve an overactive immune response that targets the body’s own tissues. In celiac disease, the trigger is gluten, while in lupus the triggers are more complex and can involve infections, hormones, or genetics.

Children who inherit genes that make them susceptible to autoimmune diseases may be at higher risk for both conditions. Environmental factors such as viral infections or dietary influences could also play a role in activating these underlying risks. Understanding these connections better may help researchers discover new treatments that target the root causes of autoimmune disease rather than just the symptoms.

Why These Findings Matter to Families Affected by Celiac Disease

For families of children with lupus, these results highlight the need for proactive screening for celiac disease even when a child does not complain of stomach problems. Early diagnosis of celiac disease allows families to make important dietary changes that can prevent further intestinal injury and improve overall well-being.

For the broader celiac community, this study underscores how complex and interconnected autoimmune diseases can be. It also reinforces that celiac disease is not just a digestive condition but an immune disorder that can appear alongside other chronic illnesses.

These findings could encourage doctors who treat children with autoimmune conditions to test more routinely for celiac disease, which might lead to earlier treatment and better outcomes. By identifying hidden cases of celiac disease in children with lupus, healthcare providers can help prevent nutrient deficiencies, growth issues, and long-term complications that might otherwise go unnoticed.

Conclusion

In summary, this study found that celiac disease is significantly more common in children and adolescents with lupus that begins in childhood than in the general pediatric population. About three percent of the lupus patients studied were confirmed to have celiac disease, and half of those had no clear digestive symptoms. The findings point to the value of routine screening for celiac disease in children with lupus, regardless of whether they show signs of stomach trouble.

For parents, patients, and doctors alike, this research offers an important reminder: autoimmune diseases often overlap, and being alert to these connections can lead to better diagnosis, treatment, and long-term health for children living with complex immune conditions.

Read more at: nature.com