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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
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Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Thiruvalla, Kerala
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Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2024 | Month : June | Volume : 18 | Issue : 6 | Page : OD04 - OD06 Full Version

Intersection of Coeliac Disease and Sjögren’s Syndrome: A Report of Two Cases

Published: June 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/69885.19469

Ravi Talapa, Rebecca Hoineikim Baite, Rishabh Rawat, Rohit Saini

1. Postgraduate Student, Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India. 2. Postgraduate Student, Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India. 3. Postgraduate Student, Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India. 4. Senior Resident, Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Correspondence Address :
Dr. Ravi Talapa,
Postgraduate Student, Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi-110001, India.
E-mail: rtblaze1998@gmail.com

Abstract

Coeliac Disease (CD) and Sjögren’s Syndrome (SS), both autoimmune disorders, are gaining attention for their complex interaction when occurring together. CD involves gluten intolerance and can present with gastrointestinal symptoms, while SS affects various organs, primarily causing dryness of the eyes and mouth. Diagnosis for each relies on specific criteria including serologic testing and histopathology. When these conditions overlap, they create unique clinical challenges, highlighting the need for a thorough understanding of their combined effects on health. This exploration aimed to uncover the intricacies of their relationship, including clinical manifestations and implications for diagnosis and management when dealing with both simultaneously. In both cases (58-year-old female and 47-year-old female), there was gastrointestinal villous atrophy as a manifestation of CD, which improved with simple dietary modification.

Keywords

Anti-tissue transglutaminase, Autoantibodies, Immunoglobulin A, Villous atrophy

Case Report
Case 1

A 58-year-old female presented with complaints of dry mouth for five months, fever persisting for one month, documented to be 100-101°F, mainly occurring at night and relieved with medication. The patient also complained of vomiting for one month consisting of food particles, accompanied by a burning sensation in the epigastric region. She had a known history of hypertension for two years on T.Amlodipine 5 mg OD, asthma for the last 10 years on Metered Dose Inhaler (MDI) Foracort 2 puffs BD, osteoarthritis for five years, and an anxiety disorder for the last year on T.Clonazepam 0.5 mg OD at bedtime.

During the general physical examination, the patient was conscious, oriented to time, place, and person, with a blood pressure of 106/70 mmHg, pulse rate of 90/min, SpO2 of 98% on room air and blood sugar level of 136 mg/dL. Pallor was present with poor oral hygiene and a dry tongue. Systemic examination of the patient was normal.

The patient underwent a series of diagnostic assessments, revealing the following results: Haemoglobin levels were measured at 10.8 grams per decilitre, with a total leukocyte count of 5400 per microlitre and a platelet count of 200,000 per microlitre. The Mean Corpuscular Volume (MCV) was determined to be 85.3 femtolitres, while total protein levels were recorded at 5.6 grams per decilitre, with albumin at 3.1 grams per decilitre. Additionally, alkaline phosphatase was 87 U/L, calcium was 8.8 mg/dL, chloride was 116 mol/dL, Creatine Kinase-MB was 6 U/L, Creatine Kinase was 49 U/L, creatinine was 1.1 mg/dL, direct bilirubin was 0.1 mg/dL, indirect bilirubin was 0.2 mg/dL, lactate dehydrogenase was 208 U/L, sodium was 134 mmol/L, potassium was 4.4 mmol/L, Parathormone was 25 pg/mL, aspartate transaminase was 37 U/L, alanine transaminase was 17 U/L, quantitative C-Reactive Protein (CRP) was 3.0 mg/dL, Total Iron Binding Capacity (TIBC) was 222 ug/dL, total iron was 59 ug/dL, urea was 11 mg/dL, uric acid was 8.5 mg/dL.

The Coronavirus Disease-2019 (COVID-19) Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was negative, C-Reactive Protein (CRP) was positive (>10 mg/dL), Rheumatic factor and anti-Cyclic Citrullinated Peptide (CCP) were negative, and urine routine was normal.

An autoimmune profile was sent for further evaluation, which was found to be strongly positive for SSA/Ro60, SSA/R052, and SSB/La. The patient also tested positive for Immunoglobulin A (IgA)-Anti-Tissue Transglutaminase (TTG). The Schirmer test was positive, and a labial biopsy (Table/Fig 1)a,b showed chronic inflammatory cell infiltrate with acinar atrophy. The upper gastrointestinal endoscopy (Table/Fig 2) revealed a 4 cm hiatus hernia and D2 scalloping, with a biopsy (Table/Fig 3) suggestive of villous atrophy.

Based on European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria, the patient was classified as SS, and based on IgA-TTG with gut biopsy was also classified as CD (1). The patient was advised to follow a gluten-free diet and receive nutritional therapy. Upon follow-up after six months, the patient’s symptoms had improved.

Case 2

A 47-year-old female presented with complaints of decreased appetite, loose stools for the last 2 months, and associated generalised weakness. She had a known case of SS for the past eight years and was taking oral cevimeline and methylcellulose eye drops from the Department of Rheumatology. The patient had been hypertensive for the last 10 years on tablet telmisartan 40 mg OD.

During a general physical examination, the patient was conscious, oriented to time, place, and person, with a blood pressure of 138/88 mmHg, a pulse rate of 74/min, SpO2 of 98% on room air, and a blood sugar level of 186 mg/dL. Mild pallor and a dry tongue were noted. Systemic examination of the patient was normal.

Following a series of investigations, the following results were obtained: Haemoglobin levels measured at 9.8 grams per decilitre (gm/dL), total leukocyte count recorded at 10,400 per microlitre (ul), and platelet count observed at 1.9 lac per microlitre (u/l). The MCV was determined to be 90.6 femtolitres (fL). Additionally, the total protein level was found to be 5.4 grams per decilitre (g/dL), with an albumin concentration of 3.2 g/dL. Alkaline phosphatase activity was measured at 60 units per liter (U/L), calcium was 9.8 mg/dL, chloride was 106 mol/dL, creatinine was 1.0 mg/dL, direct bilirubin was 0.25 mg/dL, indirect bilirubin was 0.18 mg/dL, lactate dehydrogenase was 198 U/L, sodium was 129 mmol/L, potassium was 4.6 mmol/L, aspartate transaminase was 45 U/L, alanine transaminase was 40 U/L, quantitative CRP was 3.4 mg/dL, TIBC was 282 ug/dL, total iron was 58 ug/dL, urea was 5.6 mg/dL, uric acid was 3.5 mg/dL. The COVID-19 RT-PCR was negative, CRP was positive (>10 mg/dL), Rheumatic factor and anti-CCP were negative, and urine routine was normal. The retroviral test was also negative. The patient was positive for IgA-anti-Tissue Transglutaminase (TTG). The patient’s symptoms improved after starting a gluten-free diet and nutritional therapy. On further follow-up after six months, the patient’s symptoms settled.
Discussion
The CD is a chronic autoimmune enteropathy in individuals with genetic susceptibility to gluten in the diet. It can be asymptomatic or may present as chronic diarrhoea with features of malabsorption. Diagnosis is based on serologic testing, genetic susceptibility testing, and histopathology of duodenal mucosal biopsy. On the other hand, SS is a systemic autoimmune disorder causing inflammation of the lacrimal and salivary glands. It can also involve organs such as the joints, skin, lungs, gastrointestinal tract, nervous system, and kidneys. CD and SS are both autoimmune diseases with a related genetic background and also occur in association with type 1 diabetes mellitus, autoimmune thyroid disease, and primary biliary cholangitis (2).

In the cases presented, authors encountered patients exhibiting features characteristic of both SS and CD simultaneously. In both cases, the patients presented with gastrointestinal symptoms as manifestations of CD, which was confirmed by being positive for IgA-anti-TTG. Biopsies were performed to further assess the condition, showing villous atrophy. The authors first case was also simultaneously diagnosed with SS using the American College of Rheumatology/European League against Rheumatism (EULAR/ACR) guideline, and the second case was already a known case of the same which later developed the symptoms. This convergence of symptoms prompted a closer examination, leading to the diagnosis of co-existing autoimmune conditions. The present case report underscores the importance of comprehensive assessment in patients with autoimmune disorders, especially when overlapping symptoms are present. By recognising the co-occurrence of these conditions, clinicians can implement appropriate management strategies to improve patient outcomes and quality of life.

There are consistent observations regarding the association between SS and CD. In the present case report, the presence of CD was found to be more common with SS. A study by Iltanen S et al., suggested the prevalence of CD in 34 SS patients ranges from 14.7% compared to the general population, which is only 1% (3). Another study by Luft LM et al., reported a seroprevalence of 12% in a cohort of 50 SS patients, with five out of the six positives being biopsy-confirmed CD (10%) (4). Additionally, in a study by Bartoloni E et al., 25 CD cases were reported in 354 SS patients (prevalence 7.1%), out of which 24 were biopsy-proven cases, and one was subclinical CD detected on screening (5). Another study by Caglar E et al., reported a prevalence of SS-A/SS-B antibody positivity of 6.5% in 31 CD patients (6). According to a study, 15% of patients with SS also have biopsy-proven CDs, meaning the prevalence of CD is much higher in Sjogren patients than in the general population (7).

Furthermore, insights into the potential mechanisms underlying the co-existence of these autoimmune disorders have been explored. The proposed mechanisms include increased intestinal permeability leading to a “leaky gut,” post-translational modifications of luminal proteins, and dysregulation of immune responses (8). The presence of anti-TTG antibodies in various organs, including saliva, suggests a systemic autoimmune process linking both conditions [9,10]. The case reported by Balaban DV et al., further illustrates the diagnostic challenges posed by the atypical presentation of autoimmune disorders. In their study, iron deficiency was incidentally discovered in a patient with SS, leading to the subsequent diagnosis of CD (11). This underscores the importance of vigilant clinical evaluation and consideration of underlying autoimmune aetiologies, even in the absence of overt gastrointestinal symptoms.

The presented cases highlight the clinical significance of recognising the co-occurrence of SS and CD. By integrating findings from the present case with those from existing studies, the authors underscore the importance of early detection, comprehensive evaluation, and multidisciplinary management approaches in optimising patient care for individuals with overlapping autoimmune conditions.
Conclusion
The present case report has illuminated the significant correlation between SS and CD, elucidating their prevalence rates and mutual implications. The prevalence of CD among SS patients underscores the necessity of robust screening protocols to identify and manage these concurrent autoimmune conditions effectively. Conversely, the presence of SS in CD patients highlights the bidirectional nature of their association, urging clinicians to maintain a high index of suspicion for autoimmune co-morbidities. By understanding the shared pathogenic mechanisms, such as dysregulated immune responses and genetic predispositions, healthcare providers can adopt a multidisciplinary approach to optimise patient care. Moving forward, continued research efforts are warranted to explore novel diagnostic and therapeutic strategies tailored to address the complex interplay between SS and CD, ultimately enhancing the management and quality of life for individuals affected by these autoimmune disorders.
Acknowledgement
The authors are thankful to Dr. Purnima and Dr. Nirupama from the Department of Pathology for their help in providing such wonderful histopathological slides.
Reference
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Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al. American College of Rheumatology/European league against rheumatism classification criteria for primary Sjögren’s Syndrome: A consensus and data-driven methodology involving three international patient cohorts. Arthritis Rheumatol. 2017;69(1):35-45. Doi: 10.1002/art.39859. Epub 2016 Oct 26. PMID: 27785888; PMCID: PMC5650478.   [CrossRef]  [PubMed]
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Iltanen S, Collin P, Korpela M, Holm K, Partanen J, Polvi A, et al. Celiac disease and markers of celiac disease latency in patients with primary Sjögren’s syndrome. Am J Gastroenterol. 1999;94(4):1042-46.   [CrossRef]  [PubMed]
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Bartoloni E, Bistoni O, Alunno A, Cavagna L, Nalotto L, Baldini C, et al. Celiac disease prevalence is increased in primary Sjögren’s Syndrome and diffuse systemic sclerosis: Lessons from a large multi-center study. J Clin Med. 2019;8(4):540.   [CrossRef]  [PubMed]
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Caglar E, Ugurlu S, Ozenoglu A, Can G, Kadioglu P, Dobrucali A. Autoantibody frequency in celiac disease. Clinics (Sao Paulo). 2009;64(12):1195-200.   [CrossRef]  [PubMed]
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Lidén M, Kristjánsson G, Valtýsdóttir S, Hällgren R. Gluten sensitivity in patients with primary Sjögren’s Syndrome. Scand J Gastroenterol. 2007;42(8):962-67.   [CrossRef]  [PubMed]
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Lerner A. Matthias T. Autoimmunity in celiac disease: Extra-intestinal manifestations. Autoimm Rev. 2019;18(3):241-46.   [CrossRef]  [PubMed]
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Lerner A, Aminov R, Matthias T. Dysbiosis may trigger autoimmune diseases via inappropriate posttranslational modification of host proteins. Front in Microbiol. 2016;7:84.   [CrossRef]  [PubMed]
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DOI and Others
DOI: 10.7860/JCDR/2024/69885.19469

Date of Submission: Feb 01, 2024
Date of Peer Review: Mar 05, 2024
Date of Acceptance: Apr 08, 2024
Date of Publishing: Jun 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 02, 2024
• Manual Googling: Mar 12, 2024
• iThenticate Software: Apr 06, 2024 (10%)

ETYMOLOGY: Author Origin

EMENDATIONS: 6
JCDR is now Monthly and more widely Indexed .
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  • Academic Search Complete Database
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