1
|
Kohli AT, Hersh AO, Ponder L, Chan LHK, Rouster-Stevens KA, Tebo AE, Kugathasan S, Guthery SL, Bohnsack JF, Prahalad S. Prevalence of tissue transglutaminase antibodies and IgA deficiency are not increased in juvenile idiopathic arthritis: a case-control study. Pediatr Rheumatol Online J 2023; 21:110. [PMID: 37798643 PMCID: PMC10557180 DOI: 10.1186/s12969-023-00890-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The prevalence of Celiac Disease (CD) in Juvenile Idiopathic Arthritis (JIA) has been reported to be 0.1-7% in various small studies. As a result of the limited number of research and their inconclusive results there are no clear recommendations for routine CD screening in asymptomatic patients with JIA. Our aim is to estimate the prevalence of IgA deficiency and tissue transglutaminase (tTG) IgA in a cohort of JIA followed in two large academic medical centers. METHODS Serum was collected and stored from all subjects and analyzed in a reference laboratory for total IgA (Quantitative Nephelometry) and tTG IgA antibody levels (Semi-Quantitative Enzyme-Linked Immunosorbent Assay). Fisher's exact tests were performed for statistical significance. Risk estimates (odds ratios) with 95% confidence intervals were calculated. RESULTS 808 JIA cases and 140 controls were analyzed. Majority were non-Hispanic whites (72% vs. 68% p = 0.309). A total of 1.2% of cases were IgA deficient compared to none of the controls (p = 0.373). After excluding IgA deficient subjects, 2% of cases had tTG IgA ≥ 4u/mL compared to 3.6% of controls (p = 0.216) (OR = 0.5; 95% C.I = 0.1-1.4); and 0.8% of cases had tTG IgA > 10u/mL compared to 1.4% of controls (p = 0.627) (OR = 0.5; 95%C.I = 0.1-2.9). CONCLUSIONS Using the largest JIA cohort to date to investigate prevalence of celiac antibodies, the prevalence of positive tTG IgA was 0.8% and of IgA deficiency was 1.2%. The results did not demonstrate a higher prevalence of abnormal tTG IgA in JIA. The study did not support the routine screening of asymptomatic JIA patients for CD.
Collapse
Affiliation(s)
- Angela Taneja Kohli
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Aimee O Hersh
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lori Ponder
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lai Hin Kimi Chan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelly A Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anne E Tebo
- University of Utah, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, USA
| | - Subra Kugathasan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stephen L Guthery
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - John F Bohnsack
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
2
|
Légeret C, Kutz A, Jessica B, Mundwiler E, Köhler H, Bernasconi L. Prevalence of markers of beta cell autoimmunity and thyroid disease in children with coeliac disease. BMC Pediatr 2023; 23:468. [PMID: 37716983 PMCID: PMC10504759 DOI: 10.1186/s12887-023-04294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Over the last decades, the prevalence of coeliac disease (CD), an autoimmune disorder, rose to 1-2%. Whether patients with CD have higher risk of developing other autoimmune disorders such as type 1 diabetes, Hashimoto thyroiditis, or Graves` disease remains unclear. AIM The aim of this study was to determine the prevalence of biomarkers of beta cell and thyroid autoimmunity in children with CD. METHODS Retrospective cross-sectional cohort study comparing pediatric patients suffering from CD with age and sex-matched healthy controls (HC). Participant`s serum was tested by immunoassay for following autoantibodies (aAb): TSH-receptor antibodies (TRAb), anti-thyroglobulin (anti-Tg), anti-thyroid peroxidase (anti-TPO), anti-glutamic acid decarboxylase (anti-GAD), anti-zinc transporter 8 (anti-ZnT8), anti-islet antigen 2 (anti-IA2) and anti-insulin. RESULTS A total of 95 patients with CD (mean age 8.9 years; 63% female) and 199 matched healthy controls (mean age 9.2 years; 59.8% female) were included in the study. For patients with CD, a seroprevalence of 2.1% (vs. 1.5% in HC) was calculated for anti-GAD, 1.1% for anti-IA2 (vs. 1.5% in HC), 3.2% for anti-ZnT8 (vs. 4.2% in HC), and 1.1% (vs. 1% in HC) for anti-insulin. For thyroid disease, a seroprevalence of 2.2% for TRAb (vs. 1% in HC), 0% for anti-TPO (vs. 2.5% in HC) and 4.3% for anti-Tg (vs. 3.5% in HC) was found for patients with CD. CONCLUSION This study suggests a higher prevalence of autoimmune antibodies againstthyroid in children with CD compared to HC, whilst it is similar for pancreatic antibodies. Prospective cohort studies are needed to first evaluate the occurrence of autoimmune antibodies against beta cells and thyroid over a longer follow-up time and second to explore their clinical relevance.
Collapse
Affiliation(s)
- Corinne Légeret
- Medical Faculty, University Children's Hospital Basel, Spitalstrasse 33, Basel, 4056, Switzerland.
| | - Alexander Kutz
- Division of Pharmacoepidemioloy and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, 02120, MA, USA
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Brunner Jessica
- Institute of Laboratory Medicine, Kantonsspital Aarau AG, Tellstrasse 25, Aarau, 5001, Switzerland
| | - Esther Mundwiler
- Institute of Laboratory Medicine, Kantonsspital Aarau AG, Tellstrasse 25, Aarau, 5001, Switzerland
| | - Henrik Köhler
- Medical Faculty, University Children's Hospital Basel, Spitalstrasse 33, Basel, 4056, Switzerland
- Children's Hospital Aarau, Kantonsspital Aarau AG, Tellstrasse 25, Aarau, 5001, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau AG, Tellstrasse 25, Aarau, 5001, Switzerland
| |
Collapse
|
3
|
Abdukhakimova D, Dossybayeva K, Almukhamedova Z, Mukusheva Z, Assylbekova M, Zhangabylova D, Nurgaliyeva K, Boluspayeva N, Kulmangabetova K, Hasanova L, Tanko M, Poddighe D. Serum immunoglobulin A (IgA) levels in children affected with Juvenile Idiopathic Arthritis. Heliyon 2023; 9:e17479. [PMID: 37483758 PMCID: PMC10362258 DOI: 10.1016/j.heliyon.2023.e17479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background and objective Immunoglobulin A (IgA) is the most abundant antibody isotype in the human body, considering its presence on the mucosal surfaces, in addition to the amount circulating in the bloodstream. Serum IgA levels can be variably altered in several pathological settings. However, very few studies specifically investigated serum IgA in Juvenile Idiopathic Arthritis (JIA). In the present study, we specifically assessed serum IgA levels in our cohort of patients affected with JIA. Methods In this cross-sectional study, serum IgA levels were measured in patients with JIA (and age-matched controls) and analyzed according to age class. The correlation of serum IgA levels with hematological, inflammatory, and disease activity parameters was assessed. Results No significant difference in the frequency of low IgA levels (according to the definition of complete and partial IgA deficiency) was observed between JIA patients and controls, overall. This pediatric study population showed a progressive increase of total serum IgA concentrations with age, as expected; however, in JIA patients aged 10-17 years, total IgA serum levels resulted to be significantly higher than in age-matched control subjects. No clear correlation between IgA levels and the examined inflammatory, hematological, and disease activity parameters was observed in JIA patients, except for the erythrocyte sedimentation rate (ESR) in oligoarticular JIA patients: here, serum IgA levels showed a positive and moderate covariation with ESR, which was also observed for disease activity (JADAS-10) in selected oJIA patients without biological therapy. Conclusions In our cohort of JIA patients, total serum IgA levels were not reduced and were actually increased in adolescents compared to controls. Larger studies are needed to confirm this finding, which cannot be certainly explained based on the available data in this study, even though JIA disease control and/or chronic inflammation may be implicated to some extent.
Collapse
Affiliation(s)
- Diyora Abdukhakimova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Kuanysh Dossybayeva
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Zhaina Almukhamedova
- Program of Pediatric Rheumatology, Clinical Academic Department of Pediatrics, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Zaure Mukusheva
- Program of Pediatric Rheumatology, Clinical Academic Department of Pediatrics, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Maykesh Assylbekova
- Program of Pediatric Rheumatology, Clinical Academic Department of Pediatrics, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Dilnaz Zhangabylova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Kadisha Nurgaliyeva
- Clinical Academic Department of Laboratory Medicine, Pathology and Genetics, Republican Diagnostic Center, University Medical Center, Astana, Kazakhstan
| | - Nurgul Boluspayeva
- Clinical Academic Department of Laboratory Medicine, Pathology and Genetics, Republican Diagnostic Center, University Medical Center, Astana, Kazakhstan
| | - Kenzhekhan Kulmangabetova
- Clinical Academic Department of Laboratory Medicine, Pathology and Genetics, Republican Diagnostic Center, University Medical Center, Astana, Kazakhstan
| | - Liliya Hasanova
- Pediatric Service, Clinical Academic Department of Pediatrics, University Medical Center, Astana, Kazakhstan
| | - Matthew Tanko
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Clinical Academic Department of Laboratory Medicine, Pathology and Genetics, Republican Diagnostic Center, University Medical Center, Astana, Kazakhstan
| | - Dimitri Poddighe
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Program of Pediatric Rheumatology, Clinical Academic Department of Pediatrics, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
- Clinical Academic Department of Pediatrics, University Medical Center, Astana, Kazakhstan
| |
Collapse
|
4
|
Risk of Juvenile Idiopathic Arthritis and Rheumatoid Arthritis in Patients With Celiac Disease: A Population-Based Cohort Study. Am J Gastroenterol 2022; 117:1971-1981. [PMID: 36114769 DOI: 10.14309/ajg.0000000000002014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/09/2022] [Indexed: 01/30/2023]
Abstract
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.
Collapse
|
5
|
Seroprevalence of Anti-tTg-IgA among Symptomized Celiac Disease Patients and Their Correlation with Rotavirus Infection. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6972624. [PMID: 36193310 PMCID: PMC9526599 DOI: 10.1155/2022/6972624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
Celiac disease (CD) is a chronic inflammatory disorder in the intestinal tract as a response to the use of gluten in genetically predisposed individuals. It is a worldwide problem, with a high prevalence rate in North America. This is a descriptive cross-sectional study involving 1090 samples collected from different hospitals of Rawalpindi and Islamabad, Pakistan, from January 2019 to December 2019. In this study, 1090 blood samples screened for seroprevalence of anti-tTG antibodies in CD symptomatic patients via ELISA (enzyme-linked immunosorbent assay). 1090 fecal samples from the same CD patients were collected and tested for the presence of rotavirus (RV) via ELISA and RT-PCR. Of the 1090 patients tested for seroprevalence of anti-tTG antibodies, 112/1090 (10.3%) were found to be positive. Of the 112 anti-tTG-positive patients, 78/112 (70%) were positive for RV via ELISA and 74/112 (66.1%) were RV positive via RT-PCR. A statistically significant association was reported between rotavirus infection and celiac disease (p˂0.05). Anti-tTG antibodies were higher in age group 6 (12-18 years) patients (18.4%) and at minimum in age group 3 (1-3 years) patients (4.8%). However, there was a statistically insignificant relationship between group age and CD prevalence (p > 0.05). The highest CD prevalence was noted during winter season (19.6%) and the lowest (3.0%) during fall/autumn. Our study findings demonstrate that Pakistan has a high prevalence of CD compared to other studies. Further studies in the fields of environmental risk factors and treatment with more advanced serological and histopathological studies are needed in the future.
Collapse
|
6
|
Naddei R, Di Gennaro S, Guarino A, Troncone R, Alessio M, Discepolo V. In a large Juvenile Idiopathic Arthritis (JIA) cohort, concomitant celiac disease is associated with family history of autoimmunity and a more severe JIA course: a retrospective study. Pediatr Rheumatol Online J 2022; 20:31. [PMID: 35459143 PMCID: PMC9034531 DOI: 10.1186/s12969-022-00689-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/09/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A higher prevalence of celiac disease (CD) has been reported in patients with juvenile idiopathic arthritis (JIA) compared to the general population. Factors related to the increased risk of co-occurrence and associated disease course have not been fully elucidated. Aims of this study were to determine the prevalence of CD in a large Southern Italian cohort of children with JIA, describe their clinical features and disease course and investigate risk factors associated with their co-occurrence. FINDINGS Demographic, clinical and laboratory data of all patients with JIA admitted to our Pediatric Rheumatology Unit from January 2001 to June 2019, who underwent CD screening, were retrospectively extracted from clinical charts and analyzed. Eight of 329 JIA patients were diagnosed with CD, resulting in a prevalence higher than the general Italian population (2.4% vs 0.93%, p < 0.05). Familiarity for autoimmunity was reported by 87.5% patients with JIA and CD compared to 45.8% of those without CD (p < 0.05). 87.5% patients with JIA and CD required both a conventional Disease Modifying Anti-Rheumatic Drug (DMARD) and a biological DMARD over time compared to 36.4% of those without CD (p < 0.05). CONCLUSION A higher CD prevalence was found in a large JIA cohort, supporting the need for CD screening in all JIA children, especially those with a family history of autoimmunity, found to be associated with the co-occurrence of the two diseases. This is clinically relevant since patients with CD and JIA more often required a step-up therapy, suggesting a more severe JIA clinical course.
Collapse
Affiliation(s)
- Roberta Naddei
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Simona Di Gennaro
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Alfredo Guarino
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Riccardo Troncone
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy ,grid.4691.a0000 0001 0790 385XEuropean Laboratory for the Investigation of Food Induced Diseases (ELFID), University of Naples Federico II, Naples, Italy
| | - Maria Alessio
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Valentina Discepolo
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy. .,European Laboratory for the Investigation of Food Induced Diseases (ELFID), University of Naples Federico II, Naples, Italy.
| |
Collapse
|
7
|
Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders. J Clin Med 2022; 11:jcm11041089. [PMID: 35207358 PMCID: PMC8878661 DOI: 10.3390/jcm11041089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 02/08/2023] Open
Abstract
Celiac Disease (CD) is an immune-mediated and gluten-related disorder whose prevalence is higher in children affected with other autoimmune disorders, including diabetes mellitus type 1, autoimmune thyroiditis, and others. As regards Juvenile Idiopathic Arthritis (JIA) and other pediatric rheumatic disorders, there is no clear recommendation for CD serological screening. In this review, we analyze all the available clinical studies investigating CD among children with JIA (and other rheumatic diseases), in order to provide objective data to better understand the necessity of CD serological screening during the follow-up. Based on the present literature review and analysis, >2.5% patients with JIA were diagnosed with CD; however, the CD prevalence in JIA patients may be even higher (>3–3.5%) due to several study limitations that could have underestimated CD diagnosis to a variable extent. Therefore, serological screening for CD in children affected with JIA could be recommended due to the increased CD prevalence in these patients (compared to the general pediatric population), and because these JIA patients diagnosed with CD were mostly asymptomatic. However, further research is needed to establish a cost-effective approach in terms of CD screening frequency and modalities during the follow-up for JIA patients. Conversely, at the moment, there is no evidence supporting a periodical CD screening in children affected with other rheumatic diseases (including pediatric systemic lupus erythematosus, juvenile dermatomyositis, and systemic sclerosis).
Collapse
|
8
|
Schulz C, Fuehner S, Schlüter B, Fobker M, Sengler C, Klotsche J, Niewerth M, Minden K, Foell D. Prevalence of autoantibodies in patients with juvenile idiopathic arthritis: results from the German inception cohort ICON-JIA. Pediatr Rheumatol Online J 2022; 20:8. [PMID: 35109858 PMCID: PMC8812016 DOI: 10.1186/s12969-022-00668-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An association of different autoimmune diseases is suspected. In juvenile idiopathic arthritis (JIA), only few and partially conflicting data on the co-existence of other autoimmune disorders are available. The prevalence of autoantibodies in patients with JIA in Germany is not known. METHODS Samples from 499 patients (median age at time of blood collection 11 years, median disease duration 4.4 years) in the prospective, multicenter inception cohort of children newly diagnosed with JIA (ICON-JIA) were analysed for the presence of anti-thyroid antibodies, celiac disease-specific antibodies (anti-tTG IgA, anti-tTG IgG), and connective tissue disease-associated antibodies (CTD-screen). RESULTS A total of 76 (15.2%) patients had either clinically diagnosed autoimmune comorbidity or elevated autoantibodies. Of 21 patients with clinical autoimmune comorbidity, only 8 were also serologically positive at the time of testing, while 55 patients had autoantibodies without clinical diagnosis. Thus, 63 patients (12.6%) had at least one elevated autoantibody. Antibodies against thyroglobulin were found in 3% and against thyreoperoxidase in 4% of the samples. TSH receptor antibodies could not be detected in any of the 499 patients. Tissue transglutaminase antibodies were elevated in 0.4% of the patients. A positive screen for CTD-specific antinuclear antibodies was found in 7%, but only rarely specific antibodies (anti-dsDNA 1.4%, anti-SS-A and -SS-B 0.2% each, anti-CENP-B 0.4%) were confirmed. CONCLUSIONS In our study, a specific correlation between JIA and other autoimmune phenomena could not be confirmed. The lack of well-matched control groups makes interpretation challenging. Further data need to corroborate the suspected increased risk of developing other autoimmune phenomena in JIA patients.
Collapse
Affiliation(s)
- Caroline Schulz
- grid.16149.3b0000 0004 0551 4246Department of Paediatric Rheumatology and Immunology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building D3, 48149 Muenster, Germany
| | - Sabrina Fuehner
- grid.16149.3b0000 0004 0551 4246Department of Paediatric Rheumatology and Immunology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building D3, 48149 Muenster, Germany
| | - Bernhard Schlüter
- grid.16149.3b0000 0004 0551 4246Centre of Laboratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Manfred Fobker
- grid.16149.3b0000 0004 0551 4246Centre of Laboratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Claudia Sengler
- grid.418217.90000 0000 9323 8675Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany
| | - Jens Klotsche
- grid.418217.90000 0000 9323 8675Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany
| | - Martina Niewerth
- grid.418217.90000 0000 9323 8675Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany
| | - Kirsten Minden
- grid.418217.90000 0000 9323 8675Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Medical University Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building D3, 48149, Muenster, Germany.
| |
Collapse
|
9
|
Roshanzamir N, Zakeri Z, Rostami-Nejad M, Sadeghi A, Pourhoseingholi MA, Shahbakhsh Y, Asadzadeh-Aghdaei H, Elli L, Zali MR, Rezaei-Tavirani M. Prevalence of celiac disease in patients with atypical presentations. Arab J Gastroenterol 2021; 22:220-223. [PMID: 34538760 DOI: 10.1016/j.ajg.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/02/2021] [Accepted: 05/31/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND STUDY AIMS Unawareness about atypical forms of celiac disease (CD) leads to the underdiagnoses of CD. This study has investigated the prevalence of CD in patients with atypical presentations, such as idiopathic low bone mineral density (ILBMD) and dyspepsia, in the Iranian population. PATIENTS AND METHODS Two separate groups of patients who have been diagnosed with dyspepsia and ILBMD (including either osteopenia or osteoporosis of unknown cause) were screened for CD during 2016-2019. Patients were serologically screened by means of IgA anti-tissue transglutaminase (IgA anti-tTG); in case of positive results, the patients underwent endoscopic intestinal biopsy to confirm the diagnosis of CD. RESULTS Of 200 patients with ILBMD, six (3%) had a positive result for IgA anti-tTG; in five cases (2.5%), duodenal histology confirmed the CD diagnosis. Of 290 patients with dyspepsia, 25 (8.6%) had a positive result for anti-tTG IgA; nine cases (3.7%) were histologically compatible with CD. No significant differences were found between the two groups of patients. CONCLUSIONS The prevalence of CD in patients with atypical presentations, such as ILBMD and dyspepsia, is consistent (pvalue = 0.788) and higher than that in the general population (p value = 0.001); therefore, screening program for CD in these patients is highly recommended.
Collapse
Affiliation(s)
- Navid Roshanzamir
- Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Zakeri
- Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yas Shahbakhsh
- Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh-Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Mohammad-Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|