Although it might not be at the top of your diagnostic checklist, a new study suggests pediatric rheumatologists should screen patients for celiac disease, according to Polly Ferguson, MD, chair of the American College of Rheumatology’s Pediatric Rheumatology Special Committee.
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In the article, “Unrecognized Celiac Disease in Children Presenting for Rheumatology Evaluation,”1 published in Pediatrics, researchers at the Hospital for Special Surgery in New York identified a 2% overall prevalence rate for celiac disease in children presenting for rheumatology evaluation. Most patients “ultimately received a [celiac disease] diagnosis … with extraintestinal manifestations,” write the study’s authors.
“We need to think about this,” says Dr. Ferguson, who is an associate professor and director of pediatric rheumatology in the department of pediatrics at the University of Iowa Carver College of Medicine in Des Moines. “This [diagnosis] is on our radar. Our group considers it part of the differential diagnosis for juvenile idiopathic arthritis. We regularly send, at least, a tTG-IgA test on most patients who present either with nuance of arthritis or arthralgias without a cause. It can completely change how you treat them long term.”
The tTG-IgA (tissue transglutaminase antibodies) test is the most commonly used and most sensitive test (98%) for celiac disease, but it has a high rate of false positives in patients with autoimmune disorders, according to the Celiac Disease Foundation.
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