What is it about?
Myositis are rare, multiorgan connective tissue disorders that despite modern medical therapies are associated with reduced quality of life and life expectancy. In a recent study we describe 30 published case reports of patients with myositis who also were diagnosed with celiac disease, sometimes asymptomatic and sometimes with negative serology for celiac disease (https://www.sciencedirect.com/science/article/pii/S0049017221001463). Still, after commencing a gluten-free diet for their celiac disease, 14/24 patients (58%) experienced improvement in their myositis illness, including three patients with otherwise therapy-resistant inclusion body myositis, and 7/24 (29%) remained in long-term clinical myositis remission with a gluten-free diet as the only treatment. To investigate the suggestive associations between myositis disease activity and gluten exposure, a review was performed. Here, the available evidence for common disease mechanisms between the many different subsets of idiopathic inflammatory myopathy (IIM, or myositis) and the autoimmune gluten-related disorders of celiac disease, dermatitis herpetiformis, and gluten ataxia is presented. The investigations for the review revealed that the major components involved in the adaptive immune response in the gut in celiac disease, have also been found to be present in muscle in patients with myositis who carry one or both genes for celiac disease (HLA DQ2.5+/DQ8+). The findings support a novel hypothesis, outlined in the article: that in a small subset of genetically predisposed patients with myositis, exposure to gluten may act as a driver of myositis, perhaps via direct effects in tissue outside the gastrointestinal tract.
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Why is it important?
The findings support that in patients with myositis (IIM), inclusion of the celiac gene (HLA-DQ) typing may be justified as part of the workup. In patients with myositis who carry one or both of the celiac genes, small-intestinal biopsies may be considered in order to rule out celiac disease, also if the patient does not have typical symptoms of celiac disease. Patients with myositis who are diagnosed with celiac disease after small intestinal biopsy should be encouraged to follow a strict gluten-free diet as this potentially may lead to improvement of their myositis in addition to improved gut health.
Perspectives
This is the first review to present the available literature supporting possible links between gluten exposure and some subsets of the rare myopathies. The collected available evidence is sparse and insufficient to establish dietary guidelines for patients with myositis. There is a need for research designed specifically to address the questions presented in this review. The article suggests ways to move research in this field forward through clinical trials and immunological studies. These findings may give directions for such research in order to open for new insights into how exposure to gluten may affect tissues in the body outside the gut.
Gunhild Alvik Nyborg
Oslo University Hospital
Read the Original
This page is a summary of: Inflammatory Myopathies and Autoimmune Gluten-related Disorders: A Scoping Review of Pathophysiological Interconnections and Hypothesis, Recent Advances in Inflammation & Allergy Drug Discovery, June 2025, Bentham Science Publishers,
DOI: 10.2174/0127722708317244240919113305.
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