Malabsorption and Systemic Lupus Erythematosus

(Continued from p 1900.)

To the Editor.—In reference to Rustgi and Peppercorn's article appearing in the July 1988 issue of the Archives dealing with gluten-sensitive enteropathy (GSE) and systemic lupus erythematosus (SLE),¹ we wish to point out some inaccuracies. A MEDLINE search of the literature yields eight cases of concomitant occurrence of intestinal malabsorption with typical changes of celiac disease on intestinal biopsy and SLE^2-8 (Table), not four cases, as cited in Rustgi and Peppercorn's article. They seem to ignore four other cases.^2-5 Among these four cases, a gluten-free diet (GFD) was not tried in two,^2,3 and was ineffective in one⁵; in one case⁴ celiaclike changes occurred in a patient with SLE and dermatitis herpetiformis (DH), without clinical aspects of malabsorption, and with normal small-bowel function (because of the high incidence of celiac disease in DH). A GFD was tried, but there is