Celiac Disease More Common in Patients With Juvenile Idiopathic Arthritis

Celiac.com 05/30/2022 - A recent Italian study published in Pediatric Rheumatology indicates that juvenile idiopathic arthritis patients have higher rates of celiac disease, which suggests that celiac screening would be beneficial for IA sufferers, especially those with a family history of autoimmunity. 

Since many autoimmune disorders share similar immune triggers, mechanics and contributing factors, including genetics and environment, understanding the connections, along with the factors associated with an increased susceptibility, could help researchers and clinicians to design better case-finding strategies for certain at-risk populations.

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For their retrospective study, the team gathered information, including age at diagnosis, family history, other autoimmune disorders, juvenile idiopathic arthritis subtype, and medications, from a Southern Italian group of patients with juvenile idiopathic arthritis who were admitted to the Pediatric Rheumatology Unit between January 2001 and June 2019 who underwent celiac disease screening.

Using the data, they were able to assess clinical features and disease course, along with associated risk factors when juvenile idiopathic arthritis and celiac disease happen together. 

The team evaluated juvenile idiopathic arthritis patients every 3 to 6 months and adjusted treatment in response to adverse events and disease effects.

The team's analysis is limited in part by small sample size of patients with both juvenile idiopathic arthritis and celiac disease, and because patients with juvenile idiopathic arthritis and celiac disease had longer follow-up periods than patients with juvenile idiopathic arthritis alone. 

However, since most celiac disease diagnosis occurred within 12 months of juvenile idiopathic arthritis onset, the team believes this does not influence bias.

The team concluded that:

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Of 329 patients with JIA (mean age 12.5 years, 74.8% female), 8 (2.4%) were diagnosed with CD, resulting in a higher prevalence of CD when compared with the general Italian population (2.4% vs 0.93%, p < 0.05). Autoimmunity of at least 1 first- or second-degree relative was found in 87.5% (n = 7) of patients with both JIA and CD, compared with only 45.8% of those without CD (p < 0.05).

Further, 87.5% (n =7) of patients with both JIA and CD needed a disease-modifying antirheumatic drug (DMARD) and a biological DMARD (bDMARD), compared with 36.4% of patients without CD (p < 0.05), suggesting more severe JIA course in this patient population.

They also added that the "results highlight the importance of celiac disease screening in pediatric juvenile idiopathic arthritis patients." These results are also significant for juvenile idiopathic arthritis patients who also have celiac disease, as juvenile idiopathic arthritis looks to be more aggressive in those patients, who often need step-up therapy. They note that these patients might benefit from an early introduction of a biologic drug, but more study is needed to know for sure.

They plan future studies to test whether first-line genetic testing followed by celiac disease-specific serological screening will produce better results than first-line serological screening.

Stay tuned for more on this and related stories.

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