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Risk of Juvenile Idiopathic Arthritis and Rheumatoid Arthritis in Patients With Celiac Disease: A Population-Based
John B Doyle1, Benjamin Lebwohl1, Johan Askling2
1Celiac Disease Center, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Insights
Patients with celiac disease (CD) have a significantly higher risk of developing juvenile idiopathic arthritis (JIA) and rheumatoid arthritis (RA). This study highlights the importance of evaluating joint symptoms in CD patients for these conditions.
Area of Science:
- Immunology
- Epidemiology
- Gastroenterology
Background:
- Celiac disease (CD) is linked to various immune-mediated conditions.
- A clear epidemiological link between CD and juvenile idiopathic arthritis (JIA) or rheumatoid arthritis (RA) is not well-established.
Purpose of the Study:
- To quantify the risk of developing JIA and RA in patients diagnosed with CD.
- To investigate the association between CD and these two autoimmune arthritic conditions.
Main Methods:
- A population-based cohort study in Sweden (2004-2017) identified 24,014 individuals with biopsy-proven CD.
- Patients were matched to 117,397 reference individuals from the general population.
- Cox proportional hazards models were used to estimate the relative risk of JIA (in those <18) and RA (in those ≥18).
Main Results:
- Children with CD had a 2.68 times higher risk of developing JIA (HR 2.68, 95% CI 1.82-3.95).
- Adults with CD had a 1.70 times higher risk of developing RA (HR 1.70, 95% CI 1.36-2.12).
- Incidence rates for JIA and RA were significantly elevated in CD patients compared to the general population.
Conclusions:
- Individuals with celiac disease exhibit a substantially increased risk for both juvenile idiopathic arthritis and rheumatoid arthritis.
- Clinicians should maintain a low threshold for evaluating joint symptoms in celiac disease patients for potential JIA or RA.
Introduction:
Celiac disease (CD) is associated with many immune-mediated conditions, but a definitive epidemiological association between CD and juvenile idiopathic arthritis (JIA) or rheumatoid arthritis (RA) has not been established. We quantified the risk of JIA and RA among patients with CD using a population-based cohort.
Methods:
We identified patients diagnosed with biopsy-proven CD between 2004 and 2017 using data from a national histopathology cohort in Sweden. Each patient was matched by age, sex, calendar year, and geographic region to reference individuals in the general population. We calculated the incidence and estimated the relative risk, through Cox proportional hazards models, of JIA in individuals with CD aged <18 and of RA in individuals with CD aged ≥18.
Results:
We identified 24,014 individuals with CD who were matched to 117,397 reference individuals from the general population. Among individuals aged <18, the incidence rate of JIA was 5.9 per 10,000 person-years in patients with CD and 2.2 per 10,000 person-years in the general population (n events = 40 and 73, respectively; hazard ratio [HR] 2.68, 95% confidence interval 1.82-3.95) over a follow-up of 7.0 years. Among individuals aged ≥ 18, the incidence of RA was 8.4 per 10,000 person-years in CD and 5.1 per 10,000 person-years in matched comparators (n events = 110 and 322, respectively; HR 1.70, 95% confidence interval 1.36-2.12) over a follow-up of 8.8 years.
Discussion:
Among children with CD, JIA develops nearly 3 times as often as it does in the general population, and among adults with CD, RA occurs nearly 2 times as often. Clinicians caring for patients with CD with joint symptoms should have a low threshold to evaluate for JIA or RA.
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