Frequency of Celiac Disease in a Cross-Sectional, JIA-Predominant Cohort of Children with Rheumatologic Diseases.

Abstract

Objectives: Celiac disease (CD) is an immune-mediated disorder that may present with gastrointestinal or extraintestinal manifestations or remain asymptomatic. Although an increased prevalence has been reported in some autoimmune diseases, data regarding CD frequency in pediatric rheumatologic diseases are limited, and routine screening remains controversial. This study aimed to evaluate the frequency of CD among children with rheumatologic diseases and the necessity of routine serological screening.

Methods: This cross-sectional study included 94 children with rheumatologic diseases who underwent systematic CD screening between January 2020 and November 2023. Screening was performed using anti-tissue transglutaminase immunoglobulin A and endomysial antibody tests regardless of symptoms. Patients with positive serology underwent upper gastrointestinal endoscopy and intestinal biopsy. The prevalence of biopsy-confirmed celiac disease was calculated with 95% confidence intervals.

Results: The median age was 171 months (Q1-Q3: 124.25-192.25), and 55.3% were female. Juvenile idiopathic arthritis (JIA) was the most common diagnosis (88.3%). Serological positivity suggestive of CD was detected in two patients (2.1%), both of whom were diagnosed with JIA. Biopsy-confirmed CD was identified in one patient, corresponding to a prevalence of 1.06% (95% confidence interval: 0.03-5.79), which was not significantly different from the prevalence reported in Turkish school children (two-proportion z-test, p=0.553). Both patients who underwent endoscopy had normal growth parameters and no classical gastrointestinal symptoms.

Conclusion: The prevalence of CD in children with rheumatologic diseases was low and similar to that of the general pediatric population. Routine screening for CD in asymptomatic patients with rheumatologic diseases may not be necessary, and a more individualized, risk-based approach may be more appropriate.