Risk of Juvenile Idiopathic Arthritis and Rheumatoid Arthritis in Patients With Celiac Disease: A Population-Based Cohort Study

Abstract

INTRODUCTION:Celiac disease (CD) is associated with many immune-mediated conditions, but a definitive epidemiological association between CD and juvenile idiopathic arthritis (JIA) or rheumatoid arthritis (RA) has not been established. We quantified the risk of JIA and RA among patients with CD using a population-based cohort.METHODS:We identified patients diagnosed with biopsy-proven CD between 2004 and 2017 using data from a national histopathology cohort in Sweden. Each patient was matched by age, sex, calendar year, and geographic region to reference individuals in the general population. We calculated the incidence and estimated the relative risk, through Cox proportional hazards models, of JIA in individuals with CD aged <18 and of RA in individuals with CD aged ≥18.RESULTS:We identified 24,014 individuals with CD who were matched to 117,397 reference individuals from the general population. Among individuals aged <18, the incidence rate of JIA was 5.9 per 10,000 person-years in patients with CD and 2.2 per 10,000 person-years in the general population (n events = 40 and 73, respectively; hazard ratio [HR] 2.68, 95% confidence interval 1.82–3.95) over a follow-up of 7.0 years. Among individuals aged ≥ 18, the incidence of RA was 8.4 per 10,000 person-years in CD and 5.1 per 10,000 person-years in matched comparators (n events = 110 and 322, respectively; HR 1.70, 95% confidence interval 1.36–2.12) over a follow-up of 8.8 years.DISCUSSION:Among children with CD, JIA develops nearly 3 times as often as it does in the general population, and among adults with CD, RA occurs nearly 2 times as often. Clinicians caring for patients with CD with joint symptoms should have a low threshold to evaluate for JIA or RA.

No Increased Risk of Cardiac Birth Defects in Infants of Mothers With Celiac Disease: A Population and Sibling Comparison

“…Auger et al (8) included chromosomal defects as a category in their analysis and did not specify whether congenital birth defects due to alcohol use or viral illnesses were included. Both our study and the study by Ban et al (9) also controlled for presence of rheumatoid arthritis (32) and autoimmune thyroid disease, which are more common in patients with CeD (6) and are independently associated with cardiac birth defects (30,33). The percentage of mothers with these disorders was not specified in the study by Auger et al study (8).…”

Microscopic colitis and risk of incident rheumatoid arthritis: A nationwide population‐based matched cohort study

“…Additionally, none of the studies referenced above reported results for both seropositive and seronegative RA. However, significant, positive associations between IBD and RA 24 and CD and RA 22 have been previously ascertained, and MC has also been linked to both CD and IBD 5,23 …”

“…If this information was also missing, study participants were placed in the missing category. As both MC and RA have been linked to coeliac disease 5,22 (CD) and inflammatory bowel disease 23,24 (IBD), we identified all patients with a diagnosis of IBD (defined as ≥1 biopsy consistent with IBD and ≥1 ICD‐code indicating IBD) and CD (defined by SNOMED‐code M58 or the CD diagnostic code D6218) through the ESPRESSO‐cohort 18 in order to be able to adjust for these conditions in multivariate analyses.…”