High prevalence of coeliac disease (CD) has been reported in various autoimmune disorders, but has not been studied in the antiphospholipidsyndrome (APS). We aimed to establishthe prevalenceof CD antibodiesin a cohort of APS patients, and to examine whether CD may be responsiblefor some of the manifestationsof APS. Fifty-seven patients (47 females, 10 males) with APS were studied for clinical manifestations and serological markers of the disease, as well as the presence of anti-endomysial antibodies using an ELISA assay (EMA-ELISA). Control subjects were 171 healthy individuals, ageand sex-matched (141 females). Eight patients with APS (14%, six females) were found to have EMA-ELISA antibodies, compared with 2/141 (1.1%) of controls (P 0.0003). Antibodies against b2-glycoprotein-I (b2GPI) epitopes (GRTCPKPDDLP) were more prevalent in EMA-positive patients than in EMA-negative patients (P 0.006). Vasculitic skin lesions were significantly more common in EMA-ELISA-positive compared with EMA-ELISA-negative patients (62.5 versus 16.3%, P 0.01). Among the skin manifestations, superficial cutaneous necrosis (37.5 versus 2%, P 0.007) was more prevalent in EMA-ELISA-positive than in EMA-ELISA-negative patients. EMA-ELISA antibodies are common in APS, and their presence is associated with high prevalence of antibodies recognizing certain b2-glycoprotein epitopes, and with cutaneous manifestations of APS.
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