Evaluation of screening for coeliac disease in children with juvenile idiopathic arthritis

Abstract

Aim To study the prevalence of coeliac disease (CD) in children with Juvenile idiopathic arthritis (JIA), by screening a population‐based cohort of children with JIA using autoantibodies against tissue transglutaminase (anti‐TG2). Methods All children diagnosed with JIA in three Swedish counties, with disease onset between 2007 and 2014, were included prospectively. Serum levels of IgA anti‐TG2 antibodies, IgG anti‐TG2 antibodies, and total IgA were analysed. Children with positive levels of IgA anti‐TG2 antibodies and children with IgA deficiency in combination with positive levels of IgG anti‐TG2 antibodies were referred to the paediatric gastroenterology unit for gastroscopy and small intestine biopsy. Results A total of 216 children were included, and analysis of IgA and IgG anti‐TG2 antibodies was performed in 213 children. Three children were diagnosed with CD prior to the diagnosis of JIA, and three additional children were found through screening, resulting in a CD point prevalence of 2.8% (95% CI 0.6–5.0%). Conclusion We found a point prevalence of CD close to previous described prevalence in the general population of Swedish children. Therefore, general screening for CD in children with JIA is not supported by our data. However, this study shows that asymptomatic CD in children with JIA may be found by screening.

In a large Juvenile Idiopathic Arthritis (JIA) cohort, concomitant celiac disease is associated with family history of autoimmunity and a more severe JIA course: a retrospective study

“…In line with previous data [ 9 , 10 ], at the time of CD diagnosis, most patients were asymptomatic, thus underlining the importance of systematic screening for CD among JIA patients even in the absence of suggestive symptoms.…”

“…In contrast to their study, reporting a 0,7% CD prevalence among JIA patients, but in line with other reports [ 2 – 4 , 8 , 9 ], we found a prevalence of 2,4%, more than twice higher than that of CD in the general population in Italy [ 14 ], as well as in Europe [ 15 ]. Similarly, Oman and colleagues found a CD prevalence of 2,8% among 216 Swedish JIA patients [ 10 ]. In contrast to what observed in northern European countries [ 5 , 10 ], a small Brazilian study found 4 in 45 (8,8%) JIA patients to have positive CD-specific serology, however no biopsy was performed [ 16 ].…”

“…Similarly, Oman and colleagues found a CD prevalence of 2,8% among 216 Swedish JIA patients [ 10 ]. In contrast to what observed in northern European countries [ 5 , 10 ], a small Brazilian study found 4 in 45 (8,8%) JIA patients to have positive CD-specific serology, however no biopsy was performed [ 16 ]. In contrast, no CD case was found in two small JIA cohorts from the Middle East [ 7 , 11 ].…”

Highlights in this issue

“…Also in this issue, Öman et al. report that there was no increased occurrence of coeliac disease in children with juvenile idiopathic arthritis when they were compared to healthy children. Meanwhile, Nurminen et al.…”

The Development of Extra-Articular Manifestations in Children With Enthesitis-Related Arthritis: Natural Course or Different Disease Entity?

“…Inflammatory bowel disease, including Crohn disease, ulcerative colitis and undifferentiated colitis, occurs in 5–10% of patients affected by ERA, more frequent in males, at the onset or during disease course ( 11 ). In addition, celiac disease occurs in 1–8% of patients with ERA ( 12 ), while SAPHO syndrome is an even less frequent complication characterized by axial involvement along with enthesitis and peripheral arthritis and typical cutaneous findings ( 13 , 14 ).…”