Celiac Disease More Prevalent in Patients With Juvenile Idiopathic Arthritis

A higher percentage of celiac disease (CD) was reported in a large juvenile idiopathic arthritis (JIA) cohort in Italy, which supports the need for CD screening in this patient population, especially for those with a family history of autoimmunity, according to a study published in Pediatric Rheumatology.¹

“Autoimmune disorders often share immune pathogenic mechanisms and predisposing factors, including common genetic susceptibility and environmental triggers,” investigators explained. “Understanding the extent of the co-occurrence and identifying factors associated with an increased susceptibility could be relevant to implement case-finding strategies in specific at-risk populations.”

Information, including demographics, clinical data, and laboratory data, was extracted from a Southern Italian cohort of patients with JIA and used to investigate clinical features and disease course, as well as risk factors associated with co-occurrence of JIA and CD. Clinical charts were analyzed for patients with JIA admitted to the Pediatric Rheumatology Unit between January 2001 and June 2019 who underwent CD screening. Age at diagnosis, family history, other autoimmune disorders, JIA subtype, and medications were collected. Patients with JIA were evaluated every 3 to 6 months and treatment was adjusted according to adverse events and disease activity.

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.

The small sample size of patients who had both JIA and CD is relatively small, which limited analysis of characteristics. Analyses were also limited by the retrospective nature of the study. Further, patients with JIA and CD had longer follow-up periods than those with JIA alone. However, investigators do not believe this impacts bias, as most CD diagnosis occurred within 12 months of JIA onset.

“These results underline the importance of CD screening in pediatric JIA patients,” concluded investigators. “This is particularly relevant, since the clinical course of JIA appears to be more aggressive in patients with concomitant CD, who often require a step-up therapy. Whether those patients would benefit from an early introduction of a biologic drug needs to be explored. Future studies will test whether a first-line genetic testing followed by CD-specific serological screening would be more effective than a first-line serological screening.

Reference:

Naddei R, Di Gennaro S, Guarino A, Troncone R, Alessio M, Discepolo V. 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. Pediatr Rheumatol Online J. 2022;20(1):31. Published 2022 Apr 22. doi:10.1186/s12969-022-00689-4