medwireNews: Individuals with juvenile idiopathic arthritis (JIA) have a higher-than-average incidence of celiac disease that may be associated with a family history of autoimmunity and a more severe disease course, Italian researchers report.
Valentina Discepolo and colleagues from University of Naples Federico II say that their study highlights “the importance of [celiac disease] screening in pediatric JIA patients.”
They found that 2.4% of 329 individuals (median age 12.5 years; 74.8% female) with JIA who were admitted to a single Pediatric Rheumatology Unit between 2001 and 2019 were diagnosed with celiac disease.
This rate was significantly higher than the average of 0.93% that was observed in the general Italian population over the same period.
Overall, 46.8% of participants had a positive family history of autoimmunity, including rheumatologic and non-rheumatologic diseases, but the researchers observed that the rate was significantly higher in the people with celiac disease than in those without, at 87.5% versus 45.8%.
“This was not related to one specific autoimmune condition, suggesting that predisposing factors shared across autoimmune disorders may contribute to both [celiac disease] and JIA,” Discepolo and co-authors remark.
They report in Pediatric Rheumatology that one of the eight patients with both JIA and celiac disease developed celiac disease first. The remaining seven patients developed JIA first then celiac disease a median 8.4 months later. Furthermore, celiac disease was generally asymptomatic and diagnosed following routine screening in 71.4% of those seven patients.
The researchers also found that “patients with [celiac disease] and JIA more often required a step-up therapy, suggesting a more severe JIA clinical course.”
Specifically, 87.5% of the eight patients with JIA and celiac disease required both a conventional and a biologic DMARD during a median 9.4 months of follow-up compared with 36.4% of the 321 patients without celiac disease who were followed-up for a median 5.0 months, a significant difference.
The authors conclude that further investigations should look at whether patients with celiac disease and JIA “would benefit from an early introduction of a biologic drug.”
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