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Unrecognized Celiac Disease in Children Presenting for Rheumatology Evaluation
Yekaterina Sherman1, Rose Karanicolas1, Brittany DiMarco1
1Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
Insights
Pediatric rheumatology patients have a 2.0% prevalence of celiac disease (CD). Many children with CD present with non-gastrointestinal symptoms, highlighting the need for screening in rheumatology evaluations.
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Autoimmune Diseases
Background:
- Clinical guidelines often overlook the connection between rheumatic conditions and celiac disease (CD).
- Previous studies indicate associations between rheumatic diseases and CD in both pediatric and adult populations.
- There is a need to investigate CD prevalence in children undergoing rheumatologic assessment.
Purpose of the Study:
- To determine the prevalence of celiac disease (CD) in children evaluated by pediatric rheumatology.
- To assess the clinical presentation of pediatric patients with CD in a rheumatology setting.
Main Methods:
- Retrospective chart review of 2125 patients evaluated by Pediatric Rheumatology from June 2006 to December 2013.
- Screening for CD was part of the standard initial serologic evaluation for all patients.
- Diagnosis of CD was confirmed by pediatric gastroenterology following serologic testing.
Main Results:
- 36 new cases of celiac disease (CD) were diagnosed, representing a 2.0% prevalence.
- The majority of CD patients presented with extraintestinal manifestations like myalgias, arthralgias, and rash.
- Musculoskeletal symptoms improved or resolved after initiating a gluten-free diet in diagnosed patients.
Conclusions:
- A 2.0% prevalence of celiac disease (CD) was found in children presenting for pediatric rheumatology evaluation.
- Extraintestinal symptoms are common in children with CD, underscoring the need for screening.
- Screening for CD is crucial for children undergoing rheumatologic evaluation to ensure timely diagnosis and management.
Background And Objectives:
Current clinical guidelines do not consider patients with rheumatic conditions to be at high risk for celiac disease (CD) despite numerous reported associations between the two in adults and children. The objective of this study was to evaluate the prevalence of CD among patients presenting for pediatric rheumatology evaluation.
Methods:
A total of 2125 patients presenting for initial evaluation by the Division of Pediatric Rheumatology at the Hospital for Special Surgery between June 2006 and December 2013 were screened for CD as a part of the standard initial serologic evaluation. The charts of these patients were evaluated retrospectively at the end of this period.
Results:
36 patients (30 girls, 6 boys, mean age 9.4 ± 4.3 years, range 2-16 years) received a diagnosis of CD after serologic testing and evaluation by pediatric gastroenterology. Eight additional patients with known diagnoses of CD presented during this time period. The total prevalence of CD over this 6.5-year period was 2.0%. The most common presenting complaints among patients diagnosed with CD were myalgias, arthralgias, and rash. Less frequently, patients reported gastrointestinal complaints including abdominal pain, nausea, and diarrhea. All patients reported improvement or complete resolution of their musculoskeletal symptoms after initiation of a gluten-free diet.
Conclusions:
This study identified 36 new cases of CD among children presenting for rheumatology evaluation, for an overall prevalence rate of 2.0%. The majority of patients who ultimately received a diagnosis of CD presented with extraintestinal manifestations. These results underscore the importance of screening children presenting for rheumatology evaluation for CD.
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