Celiac Disease and Non-celiac Gluten Sensitivity Screening in Juvenile Idiopathic Arthritis Patients

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children characterized by autoimmune etiology. In previous studies, increased Celiac disease (CD) frequency was reported in patients diagnosed with JIA. In this study, CD and non-celiac gluten sensitivity (NCGS) in patients diagnosed with JIA were investigated. METHODS: Sixty-one (57.3%) JIA patients admitted to the pediatric rheumatology outpatient clinic between January 2020 and April 2020 were included in this cross-sectional study. All patients were evaluated with clinical and laboratory findings in terms of CD and NCGS. Total immunoglobulin (Ig)-A, tissue transglutaminase antibody (tTG) IgA and IgG, anti-endomysium-antibody (EMA) IgA and IgG and anti-gliadin-antibody (AGA) IgA and IgG levels were measured in all patients. RESULTS: Sixty-one JIA patients, 35 girls, were included in the study. The mean age of the patients was 11.4 ± 4.6 years, the mean age at diagnosis is 10.2 ± 3.4 years. Thirty-three patients were diagnosed with oligoarticular JIA; 18 patients with enthesitis-related arthritis, 8 patients with polyarticular JIA, and 2 patients with psoriatic arthritis. All patients were using disease-modifying antirheumatic drugs during the study. Thirty-five patients were receiving biological therapy, concomitantly. Two patients had abdominal pain, two patients had indigestion, and two patients had constipation. None of the patients had growth retardation. EMA IgA and IgG, tTG IgA and IgG, AGA IgA and IgG tests were negative in all patients. DISCUSSION AND CONCLUSION: CD and NCGS were not detected in our JIA patients. Multi-center studies may guide clinicians in under what circumstances to perform CD and NCGS screening in JIA patients.

Serological screening for coeliac disease in adults with Turner's syndrome: prevalence and clinical significance of endomysium antibody positivity

ObjectiveTo investigate the prevalence of coeliac disease (CD) in an adult population with Turner's syndrome (TS).DesignA clinic population with TS was screened using a serological test for CD.MethodsTwo hundred and fifty six patients with TS were included in the study. Five patients had existing diagnoses of CD. The remaining 251 asymptomatic patients were screened using an IgA endomysium antibody (EMA) test. Positive cases were offered endoscopy with duodenal biopsy. HLA typing was undertaken in existing cases and new EMA-positive cases.ResultsOf the 251 patients screened, eight were found to be EMA positive (3.2%). Seven patients proceeded to duodenal biopsy on which all were confirmed histologically to have CD (2.8%). The prevalence of subclinical CD in the population can therefore be estimated between 2.8 and 3.2%. The total population prevalence of CD, including the previously diagnosed cases, is estimated between 4.7 and 5.1%. Ten patients with histologically confirmed CD underwent HLA typing of which eight were HLA-DQ2 positive, one was HLA-DQ8 positive and one was negative to both HLA-DQ2 and HLA-DQ8.ConclusionsThis study demonstrates an increased prevalence of CD in an adult population with TS over the general population. This is consistent with previous data published in paediatric populations.

Serological screening for coeliac disease in adults with Turner's syndrome: prevalence and clinical significance of endomysium antibody positivity

ObjectiveTo investigate the prevalence of coeliac disease (CD) in an adult population with Turner's syndrome (TS).DesignA clinic population with TS was screened using a serological test for CD.MethodsTwo hundred and fifty six patients with TS were included in the study. Five patients had existing diagnoses of CD. The remaining 251 asymptomatic patients were screened using an IgA endomysium antibody (EMA) test. Positive cases were offered endoscopy with duodenal biopsy. HLA typing was undertaken in existing cases and new EMA-positive cases.ResultsOf the 251 patients screened, eight were found to be EMA positive (3.2%). Seven patients proceeded to duodenal biopsy on which all were confirmed histologically to have cluster of differentiation (2.8%). The prevalence of subclinical cluster of differentiation in the population can therefore be estimated between 2.8 and 3.2%. The total population prevalence of CD, including the previously diagnosed cases, is estimated between 4.7 and 5.1%. Ten patients with histologically confirmed cluster of differentiation underwent HLA typing of which eight were HLA-DQ2 positive, one was HLA-DQ8 positive and one was negative to both HLA-DQ2 and HLA-DQ8.ConclusionsThis study demonstrates an increased prevalence of cluster of differentiation in an adult population with TS over the general population. This is consistent with previous data published in paediatric populations.

Prevalence of Celiac Disease in Collagenous and Lymphocytic Colitis

Both collagenous and lymphocytic colitis have been described in patients with celiac disease, suggesting an association between the conditions. Over the past few years, the availability, sensitivity and specificity of serological markers for celiac disease have improved - the most recent advancement being the description of tissue transglutaminase as the major antigen for endomysium antibody. A quantitative ELISA was used to measure titres of immunoglobulin A (IgA) antibody to tissue transglutaminase (tTG) along with an immunofluorescent technique for IgA endomysium antibody (EmA) in 15 patients with lymphocytic colitis and eight with collagenous colitis to determine whether celiac disease latency could be detected. One patient with lymphocytic colitis demonstrated both elevated titres of tTG antibody and positive EmA, and small bowel biopsy confirmed celiac disease. One patient with collagenous colitis had a slightly elevated titre of tTG antibody with a negative EmA, and results of a small bowel biopsy were normal. Three other patients with lymphocytic colitis were already treated for previously diagnosed celiac disease. The prevalence of celiac disease occurring in lymphocytic colitis was found to be 27%, but no cases of celiac disease in association with collagenous colitis were found.

Increased Prevalence of Celiac Disease in Girls with Turner Syndrome Detected Using Antibodies to Endomysium and Tissue Transglutaminase

OBJECTIVE: To establish the prevalence of celiac disease (CD) in girls with Turner syndrome (TS) in British Columbia.METHODS: Forty-five girls with TS were prospectively screened for CD using blinded testing with the current ’gold standard’ - immunoglobulin A (IgA) endomysium antibody (EmA) and the novel IgA tissue transglutaminase antibody (tTG). Those with positive results were offered small bowel biopsies, and a gluten-free diet was recommended if CD was confirmed.RESULTS: One asymptomatic prepubertal East Indian girl was positive for EmA, had an elevated tTG concentration of 560 U/mL and histological evidence of CD. Seven girls were negative for EmA but had elevated tTG concentrations (175 to 250 U/mL); five were white, one was Asian and one was East Indian. Small bowel biopsies were performed on three girls, and the histologies were normal. The remaining four patients declined biopsy.CONCLUSIONS: One girl with TS was identified with CD from 45 screened, giving an overall biopsy-confirmed prevalence of 2.2%. This study confirms previous observations placing girls with TS at higher risk for CD and suggests a similar high prevalence in British Columbia.