Clinicians Encouraged to Assess Patients With Celiac Disease for Inflammatory Arthritis

Children with celiac disease (CD) develop juvenile idiopathic arthritis (JIA) nearly 3 times as often as the general population, while adults with celiac disease develop rheumatoid arthritis at twice the rate of adults without CD, Swedish researchers have found.

“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,” the investigators explained in their article in the American Journal of Gastroenterology.

The team used a national registry to identify patients diagnosed with biopsy-proven CD between 2004 and 2017 and matched each patient by sex, age, calendar year, and geographic area with reference individuals from the general population. From the data collected they calculated the incidence of JIA among patients with CD under the age of 18 and that of RA among adults over 18 diagnosed with CD and estimated the relative risks.

“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,” the authors wrote. “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.”

They concluded, “Clinicians caring for patients with CD with joint symptoms should have a low threshold to evaluate for JIA or RA.”

—Rebecca Mashaw

Reference:

Doyle JB, Lebwohl B, Askling J, et al. Risk of juvenile idiopathic arthritis and rheumatoid arthritis in patients with celiac disease: a population-based cohort study. Am J Gastroenterol. 2022;117(12):1971-1981. DOI: 10.14309/ajg.0000000000002014