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American Academy of Pediatrics
Article

Unrecognized Celiac Disease in Children Presenting for Rheumatology Evaluation

Yekaterina Sherman, Rose Karanicolas, Brittany DiMarco, Nancy Pan, Alexa B. Adams, Laura V. Barinstein, L. Nandini Moorthy and Thomas J. A. Lehman
Pediatrics July 2015, 136 (1) e68-e75; DOI: https://doi.org/10.1542/peds.2014-2379
Yekaterina Sherman
aDivision of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
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Rose Karanicolas
aDivision of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
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Brittany DiMarco
aDivision of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
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Nancy Pan
aDivision of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
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Alexa B. Adams
aDivision of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
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Laura V. Barinstein
bDivision of Rheumatology, Mount Sinai Medical Center, New York, New York; and
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L. Nandini Moorthy
cDivision of Pediatric Rheumatology, Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Thomas J. A. Lehman
aDivision of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
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Abstract

BACKGROUND AND OBJECTIVES: Current clinical guidelines do not consider patients with rheumatic conditions to be at high risk for celiac disease (CD) despite numerous reported associations between the two in adults and children. The objective of this study was to evaluate the prevalence of CD among patients presenting for pediatric rheumatology evaluation.

METHODS: A total of 2125 patients presenting for initial evaluation by the Division of Pediatric Rheumatology at the Hospital for Special Surgery between June 2006 and December 2013 were screened for CD as a part of the standard initial serologic evaluation. The charts of these patients were evaluated retrospectively at the end of this period.

RESULTS: 36 patients (30 girls, 6 boys, mean age 9.4 ± 4.3 years, range 2–16 years) received a diagnosis of CD after serologic testing and evaluation by pediatric gastroenterology. Eight additional patients with known diagnoses of CD presented during this time period. The total prevalence of CD over this 6.5-year period was 2.0%. The most common presenting complaints among patients diagnosed with CD were myalgias, arthralgias, and rash. Less frequently, patients reported gastrointestinal complaints including abdominal pain, nausea, and diarrhea. All patients reported improvement or complete resolution of their musculoskeletal symptoms after initiation of a gluten-free diet.

CONCLUSIONS: This study identified 36 new cases of CD among children presenting for rheumatology evaluation, for an overall prevalence rate of 2.0%. The majority of patients who ultimately received a diagnosis of CD presented with extraintestinal manifestations. These results underscore the importance of screening children presenting for rheumatology evaluation for CD.

  • Accepted April 17, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics

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Pediatrics
Vol. 136, Issue 1
1 Jul 2015
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Unrecognized Celiac Disease in Children Presenting for Rheumatology Evaluation
Yekaterina Sherman, Rose Karanicolas, Brittany DiMarco, Nancy Pan, Alexa B. Adams, Laura V. Barinstein, L. Nandini Moorthy, Thomas J. A. Lehman
Pediatrics Jul 2015, 136 (1) e68-e75; DOI: 10.1542/peds.2014-2379

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Unrecognized Celiac Disease in Children Presenting for Rheumatology Evaluation
Yekaterina Sherman, Rose Karanicolas, Brittany DiMarco, Nancy Pan, Alexa B. Adams, Laura V. Barinstein, L. Nandini Moorthy, Thomas J. A. Lehman
Pediatrics Jul 2015, 136 (1) e68-e75; DOI: 10.1542/peds.2014-2379
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