Increased risk of uveitis in coeliac disease: a nationwide cohort study
- 1Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- 2St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
- 3Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
- Correspondence to Dr Kaziwe Mollazadegan, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm 171 76, Sweden;
Contributors JFL, KM, LT and MK: Contributed to the design of the study and interpretation of the data analyses, gave guidance on the development of statistical models, approved the final version of the paper and were responsible for data integrity. JFL and KM: Collected and analysed the data and performed experiments for the study. KM: Wrote the first draft of the paper. JFL: Contributed to the writing of the paper. JFL and MK: Obtained funding.
- Accepted 20 February 2012
- Published Online First 9 March 2012
Background Case reports suggest a potential association between coeliac disease (CD) and uveitis, but larger well-controlled studies are lacking. The aim of this study was therefore to examine the risk of uveitis in patients with biopsy-verified CD.
Methods Small intestinal biopsy reports performed between July 1969 and February 2008 were collected from all (n=28) pathology departments in Sweden. From these reports, 29 044 patients with CD (equals villous atrophy, Marsh 3) were identified. Uveitis was defined according to relevant International Classification of Disease codes in the Swedish National Patient Register. Cox regression was used to estimate HR for uveitis in individuals with CD compared with those in reference individuals matched for age, sex, county and calendar year.
Results During follow-up, 148 patients with CD developed uveitis (expected count 112), corresponding to a HR of 1.32 (95% CI 1.10 to 1.58). The absolute risk of uveitis was 50/100 000 person-years in CD. The risk estimate did not change more than marginally when adjusted for type 1 diabetes, rheumatoid arthritis and autoimmune thyroid disease (HR 1.30; 95% CI 1.08 to 1.56). The risk of uveitis remained significantly increased even 5 years after CD diagnosis (HR 1.31; 95% CI 1.04 to 1.64).
Conclusion A moderately increased risk of uveitis was found in patients with biopsy-verified CD. CD might be considered in patients with uveitis of unknown aetiology.
- Coeliac disease
- cohort studies
Funding KM and MK were supported through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and the Karolinska Institutet, Stockholm. MK was also supported by grants from the Sven Jerring Foundation and Ögonfonden. This project (through author JFL) was also supported by grants from the Swedish Society of Medicine, the Swedish Research Council–Medicine (522-2A09-195), the Sven Jerring Foundation, the Örebro Society of Medicine, the Karolinska Institutet, Örebro University Hospital, the Clas Groschinsky Foundation, the Juhlin Foundation, the Majblomman Foundation, Uppsala–Örebro Regional Research Council and the Swedish Coeliac Society. The funding organisations had no role in the design or conduct of this research.
Competing interests None.
Ethics approval This project (2006/633-31/4) was approved on 14 June 2006 by the Research Ethics Committee of the Karolinska Institute, Sweden.
Provenance and peer review Not commissioned; externally peer reviewed.