Serological screening for coeliac disease in patients with juvenile idiopathic arthritis

Şahin, Yasin; Şahin, Sezgin; Barut, Kenan; Çokuğraş, Fügen; Erkan, Tülay; Adroviç, Amra; Kutlu, Tufan; Kasapçopur, Özgür

doi:10.1016/j.ajg.2019.05.005

Cited by 16 publications

(16 citation statements)

References 28 publications

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“…In order to investigate the epidemiological burden of CD in JIA patients, the literature search was performed using PubMed with the keywords (["children"] AND "Celiac Disease" AND "arthritis" OR "Juvenile Idiopathic Arthritis") restricted between 2000 and 2021 (31 December). Only the clinical studies describing cohorts (not case reports or series) of JIA patients screened for CD were included for data extraction, as summarized in Table 1 [15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Juvenile Idiopathic Arthritis and Celiac Diseasementioning

confidence: 99%

Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders

Poddighe

Romano

Dossybayeva

et al. 2022

JCM

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Celiac Disease (CD) is an immune-mediated and gluten-related disorder whose prevalence is higher in children affected with other autoimmune disorders, including diabetes mellitus type 1, autoimmune thyroiditis, and others. As regards Juvenile Idiopathic Arthritis (JIA) and other pediatric rheumatic disorders, there is no clear recommendation for CD serological screening. In this review, we analyze all the available clinical studies investigating CD among children with JIA (and other rheumatic diseases), in order to provide objective data to better understand the necessity of CD serological screening during the follow-up. Based on the present literature review and analysis, >2.5% patients with JIA were diagnosed with CD; however, the CD prevalence in JIA patients may be even higher (>3–3.5%) due to several study limitations that could have underestimated CD diagnosis to a variable extent. Therefore, serological screening for CD in children affected with JIA could be recommended due to the increased CD prevalence in these patients (compared to the general pediatric population), and because these JIA patients diagnosed with CD were mostly asymptomatic. However, further research is needed to establish a cost-effective approach in terms of CD screening frequency and modalities during the follow-up for JIA patients. Conversely, at the moment, there is no evidence supporting a periodical CD screening in children affected with other rheumatic diseases (including pediatric systemic lupus erythematosus, juvenile dermatomyositis, and systemic sclerosis).

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Section: Juvenile Idiopathic Arthritis and Celiac Diseasementioning

confidence: 99%

Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders

Poddighe

Romano

Dossybayeva

et al. 2022

JCM

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…Celiac disease (CD) is an autoimmune disorder elicited by dietary gluten, characterized by high titers of anti-tissue transglutaminase2 (anti-tTG) antibodies and the development of a small intestinal enteropathy that revert on a gluten-free diet (GFD). The prevalence of CD has been reported to be consistently higher in patients with juvenile idiopathic arthritis (JIA) in comparison to the general population, however not negligible variations have been observed in distinct geographic locations [ 2 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background A higher prevalence of celiac disease (CD) has been reported in patients with juvenile idiopathic arthritis (JIA) compared to the general population. Factors related to the increased risk of co-occurrence and associated disease course have not been fully elucidated. Aims of this study were to determine the prevalence of CD in a large Southern Italian cohort of children with JIA, describe their clinical features and disease course and investigate risk factors associated with their co-occurrence. Findings Demographic, clinical and laboratory data of all patients with JIA admitted to our Pediatric Rheumatology Unit from January 2001 to June 2019, who underwent CD screening, were retrospectively extracted from clinical charts and analyzed. Eight of 329 JIA patients were diagnosed with CD, resulting in a prevalence higher than the general Italian population (2.4% vs 0.93%, p < 0.05). Familiarity for autoimmunity was reported by 87.5% patients with JIA and CD compared to 45.8% of those without CD (p < 0.05). 87.5% patients with JIA and CD required both a conventional Disease Modifying Anti-Rheumatic Drug (DMARD) and a biological DMARD over time compared to 36.4% of those without CD (p < 0.05). Conclusion A higher CD prevalence was found in a large JIA cohort, supporting the need for CD screening in all JIA children, especially those with a family history of autoimmunity, found to be associated with the co-occurrence of the two diseases. This is clinically relevant since patients with CD and JIA more often required a step-up therapy, suggesting a more severe JIA clinical course.

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“…A study from Iran also tested 53 children for anti-tTG IgA (anti-tissue transglutaminase), of which only one child (1.8%) had elevated levels [ 11 ]. Another study found no child with elevated anti-tTG levels among 96 JIA patients [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of autoantibodies in patients with juvenile idiopathic arthritis: results from the German inception cohort ICON-JIA

et al. 2022

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Background An association of different autoimmune diseases is suspected. In juvenile idiopathic arthritis (JIA), only few and partially conflicting data on the co-existence of other autoimmune disorders are available. The prevalence of autoantibodies in patients with JIA in Germany is not known. Methods Samples from 499 patients (median age at time of blood collection 11 years, median disease duration 4.4 years) in the prospective, multicenter inception cohort of children newly diagnosed with JIA (ICON-JIA) were analysed for the presence of anti-thyroid antibodies, celiac disease-specific antibodies (anti-tTG IgA, anti-tTG IgG), and connective tissue disease-associated antibodies (CTD-screen). Results A total of 76 (15.2%) patients had either clinically diagnosed autoimmune comorbidity or elevated autoantibodies. Of 21 patients with clinical autoimmune comorbidity, only 8 were also serologically positive at the time of testing, while 55 patients had autoantibodies without clinical diagnosis. Thus, 63 patients (12.6%) had at least one elevated autoantibody. Antibodies against thyroglobulin were found in 3% and against thyreoperoxidase in 4% of the samples. TSH receptor antibodies could not be detected in any of the 499 patients. Tissue transglutaminase antibodies were elevated in 0.4% of the patients. A positive screen for CTD-specific antinuclear antibodies was found in 7%, but only rarely specific antibodies (anti-dsDNA 1.4%, anti-SS-A and -SS-B 0.2% each, anti-CENP-B 0.4%) were confirmed. Conclusions In our study, a specific correlation between JIA and other autoimmune phenomena could not be confirmed. The lack of well-matched control groups makes interpretation challenging. Further data need to corroborate the suspected increased risk of developing other autoimmune phenomena in JIA patients.

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Serological screening for coeliac disease in patients with juvenile idiopathic arthritis

Cited by 16 publications

References 28 publications

Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders

Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders

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

Prevalence of autoantibodies in patients with juvenile idiopathic arthritis: results from the German inception cohort ICON-JIA

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