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Asymptomatic celiac sprue in juvenile rheumatic diseases children
Tamer A Gheita1, Samar M Fawzy, Abeer M Nour El-Din
1Department of Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Screening for celiac disease (CD) in children with rheumatic diseases is crucial. Tissue transglutaminase (tTG) antibodies can identify asymptomatic CD, particularly in those with active juvenile rheumatoid arthritis or low BMI.
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Autoimmune Diseases
Background:
- Celiac disease (CD) is a common enteropathy in adults, frequently co-occurring with other autoimmune conditions.
- Early detection of asymptomatic CD in pediatric rheumatic diseases is essential for management.
Purpose of the Study:
- To screen for asymptomatic celiac disease (CD) in children diagnosed with rheumatic diseases.
- To assess the correlation between tissue transglutaminase (tTG) antibodies and disease activity in these pediatric patients.
Main Methods:
- Sixty children with various juvenile rheumatic diseases were enrolled, alongside thirty healthy controls.
- Tissue transglutaminase (tTG) antibodies (IgA and IgG) were measured in all participants, who were asymptomatic for gastrointestinal symptoms.
- Demographic, clinical, and laboratory data, including BMI, were collected and analyzed.
Main Results:
- A significantly higher prevalence of positive tTG antibodies was observed in children with rheumatic diseases (53.3%) compared to controls (20%).
- tTG positivity was more common in female patients.
- tTG-positive patients exhibited lower BMI and higher markers of inflammation and disease activity.
Conclusions:
- Tissue transglutaminase (tTG) antibody testing serves as a valuable screening tool for identifying asymptomatic celiac disease (CD) in children with juvenile rheumatic diseases.
- Screening is particularly recommended for children with active juvenile rheumatoid arthritis (JRA) or a notable decrease in BMI.
Background:
Celiac disease (CD) is the most frequent enteropathy in adults and its coexistence with other autoimmune diseases is frequent.
Objective:
To detect asymptomatic CD in children with rheumatic diseases by measuring tissue transglutaminase (tTG) antibodies and finding any relation to disease activity.
Patients And Methods:
Setting and study design: The study included 60 children with juvenile rheumatic diseases consecutively from those attending the Rheumatology Clinics of Cairo University Hospitals: 30 juvenile rheumatoid arthritis (JRA), 10 juvenile systemic lupus erythematosus (SLE), 12 juvenile seronegative spondyloarthropathy and eight juvenile systemic sclerosis/polymyositis (SSc/PM) overlap syndrome were recruited during 2010. There were 22 male and 38 female patients. Thirty matched healthy controls were included. All children were subjected to thorough history taking, clinical examination and laboratory investigations. The body mass index (BMI) for age was used. All subjects had no gastrointestinal tract symptoms suggestive of CD and the tTG antibodies (IgA and IgG) were assessed.
Results:
The mean age of patients was 12.03 ± 3.3 years and disease duration 4.18 ± 3.24 years. The demographic, clinical and laboratory features of the children were studied and compared. The tTG was positive in 32 (53.3%) patients compared to 20% of the controls (P = 0.03), being higher in females. In tTG-positive patients, the BMI was significantly lower, while white blood cell count, erythrocyte sedimentation rate and disease activity were significantly higher.
Conclusions:
tTG antibodies may be used as a screening test to identify asymptomatic CD associated with juvenile rheumatic diseases, especially those with active JRA or marked reduction in BMI.
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