Low BMI flags celiac disease screening in juvenile rheumatic disease patients
MedWire News: Children with rheumatic disease and a low body mass index (BMI) should be screened for asymptomatic celiac disease (CD), Egyptian researchers recommend.
The team found that over half of children attending rheumatology clinics who underwent tests for the gastroenterologic condition were positive for tissue transglutaminase (tTG) autoantibodies.
"The development of the serological test involving tTG antibodies for the diagnosis of CD made its screening a realistic possibility," say Tamer Gheita (Cairo University, Egypt) and co-workers.
CD and rheumatic conditions are known to commonly overlap in children and adults, due to their shared genetic etiology, but CD symptoms are often atypical, leading to underdiagnosis, the researchers explain.
To investigate further, the team tested for tTG autoantibodies in 60 children, aged an average of 12 years, attending rheumatology clinics in Cairo during 2010 for juvenile rheumatoid arthritis (n=30), juvenile systemic lupus erythematosus (n=10), juvenile seronegative spondyloarthropathy (n=12), or juvenile systemic scelerosis/polymyositis (n=8). Thirty age- and gender-matched healthy children were also screened for CD.
Although none of the patients or controls had gastrointestinal symptoms, tTG antibodies were present in 53.3% of patients and 20.0% of controls, and this difference in rate was significant, the researchers report in International Journal of Rheumatic Diseases. Of note, tTG positivity was significantly more common in girls than boys (71.43 vs 54.54%).
Analysis showed that patients with a positive tTG test had a significantly lower BMI than those without (16.94 vs 19.14 kg/m2). A positive test for CD was also associated with significantly elevated white blood cell counts and erythrocyte sedimentation rates, and with significantly greater disease activity in the patients.
"Marked reduction in BMI of juvenile rheumatic diseases patients should raise the suspicion for CD," the researchers conclude.
"It is recommended that tTG antibodies are used as a screening test to identify asymptomatic CD in children with juvenile rheumatic diseases."
By Lynda Williams