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Celiac Disease Screening Important for Kids Presenting for Rheumatology Evaluation

Celiac.com 07/09/2015 - Children presenting for rheumatology evaluation have undiagnosed celiac disease at double the rates of the general population, says the latest study.

Photo: CC--Eden, Janine and Jim.However, current clinical guidelines do not consider patients with rheumatic conditions to be at high risk for celiac disease despite numerous reported associations between the two in adults and children.

A team of researchers set out to assess the prevalence of celiac disease among kids receiving a rheumatology evaluation. The research team included Yekaterina Sherman, BA, Rose Karanicolas, MD, Brittany DiMarco, BA, Nancy Pan, MD, Alexa B. Adams, MD, Laura V. Barinstein, MD, L. Nandini Moorthy, MD, and Thomas J. A. Lehman, MD. They are variously affiliated with the Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York; the Division of Rheumatology, Mount Sinai Medical Center, New York, New York; and the Division of Pediatric Rheumatology, Robert Wood Johnson Medical School in New Brunswick, New Jersey.

The team conducted celiac disease screenings on a total of 2,125 patients presenting for initial evaluation by the Division of Pediatric Rheumatology at the Hospital for Special Surgery between June 2006 and December 201, as a part of the standard initial serologic evaluation. The team then reviewed the charts at the end of this period. From this information, the team diagnosed celiac disease in a total of 36 patients (30 girls, 6 boys, mean age 9.4 ± 4.3 years, range 2–16 years), after serologic testing and evaluation by pediatric gastroenterology.

Eight additional patients with known celiac disease diagnoses presented during this time period. The total prevalence of celiac disease over this 6.5-year period was 2.0%. The most commonly reported complaints among patients diagnosed with celiac disease were myalgias, arthralgias, and skin rash.

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Less frequently, patients reported gastrointestinal complaints including abdominal pain, nausea, and diarrhea.

All patients reported improvement or complete resolution of their musculoskeletal symptoms after beginning a gluten-free diet.

In this study, the team found 36 new cases of celiac disease among children presenting for rheumatology evaluation, for an overall prevalence rate of 2.0%.

The majority of patients who ultimately received a diagnosis of celiac disease presented with extra-intestinal manifestations.

These results underscore the importance of celiac disease screening in children receiving a rheumatology evaluation.

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