Unrecognized Celiac Disease in Children Presenting for Rheumatology Evaluation

Abstract

BACKGROUND AND OBJECTIVES: Current clinical guidelines do not consider patients with rheumatic conditions to be at high risk for celiac disease (CD) despite numerous reported associations between the two in adults and children. The objective of this study was to evaluate the prevalence of CD among patients presenting for pediatric rheumatology evaluation.METHODS: A total of 2125 patients presenting for initial evaluation by the Division of Pediatric Rheumatology at the Hospital for Special Surgery between June 2006 and December 2013 were screened for CD as a part of the standard initial serologic evaluation. The charts of these patients were evaluated retrospectively at the end of this period.RESULTS: 36 patients (30 girls, 6 boys, mean age 9.4 6 4.3 years, range 2-16 years) received a diagnosis of CD after serologic testing and evaluation by pediatric gastroenterology. Eight additional patients with known diagnoses of CD presented during this time period. The total prevalence of CD over this 6.5-year period was 2.0%. The most common presenting complaints among patients diagnosed with CD were myalgias, arthralgias, and rash. Less frequently, patients reported gastrointestinal complaints including abdominal pain, nausea, and diarrhea. All patients reported improvement or complete resolution of their musculoskeletal symptoms after initiation of a gluten-free diet.CONCLUSIONS: This study identified 36 new cases of CD among children presenting for rheumatology evaluation, for an overall prevalence rate of 2.0%. The majority of patients who ultimately received a diagnosis of CD presented with extraintestinal manifestations. These results underscore the importance of screening children presenting for rheumatology evaluation for CD. WHAT'S KNOWN ON THIS SUBJECT:Associations have been reported between celiac disease (CD) and numerous autoimmune conditions in adults and children. However, current screening guidelines do not consider patients with rheumatic diseases to be at high risk for CD. WHAT THIS STUDY ADDS:The prevalence of CD in children presenting for rheumatology evaluation was found to be 2% by routine serologic screening. The majority of screening-detected CD cases had no CD-associated symptoms. Gluten restriction was found to relieve some musculoskeletal complaints.

Serological Screening of Celiac Disease in Patients with Juvenile Idiopathic Arthritis

“…2 On the basis of multiple studies including ours, absence of clinical manifestation or growth failure in JIA patients cannot exclude CD. 3,5 Therefore, patients with rheumatological complaints are considered to be at higher risk for CD. Also, the presence of symptoms such as inadequate response to routine treatments of JIA can raise the suspicion of the CD.…”

“…2 The association between CD and JIA has been reported in some studies and its prevalence is reported at 1%-10%. 3 Therefore, CD should be considered in patients with JIA when unexplained extraarticular symptoms occur. 3 There are still some questions about the association of these diseases; for example, whether CD should be screened in all patients with JIA before initiation of treatment.…”

“…3 Therefore, CD should be considered in patients with JIA when unexplained extraarticular symptoms occur. 3 There are still some questions about the association of these diseases; for example, whether CD should be screened in all patients with JIA before initiation of treatment. Is this association due to the common background of two different diseases with different treatments 3,4 ?…”

“…3 There are still some questions about the association of these diseases; for example, whether CD should be screened in all patients with JIA before initiation of treatment. Is this association due to the common background of two different diseases with different treatments 3,4 ? The results of different studies are not similar and the relationship between these two diseases is currently unclear.…”

The Value of Screening for Celiac Disease in Systemic Lupus Erythematosus: A Single Experience of a Tertiary Medical Center

“…These manifest in a wide spectrum, including recurrent abdominal pain, vomiting, malabsorption, enteritis, pancreatitis, and others [ 1 – 3 ]. T-cell-induced immune-mediated disease triggered by gluten-containing food ingestion is known to be a cause of celiac disease (CD) among genetically predisposed individuals [ 4 ]. It has diverse clinical presentations, ranging from enteropathy with signs of severe malabsorption to asymptomatic presentation [ 5 – 7 ].…”