Background/Purpose: The caregivers of children with juvenile idiopathic arthritis (JIA) frequently ask about the utility of dietary restrictions. Some patients and physicians report a good response to gluten-free diets anecdotally, but the evidence to support a gluten-free diet among children with JIA is limited to 2 small case series, with a total of 8 patients.

Methods: This is a single center pilot study of a gluten-free diet in patients with JIA. Exclusion criteria were diagnoses of systemic JIA, inflammatory bowel disease, or celiac disease. All patients were screened for occult celiac disease and excluded if positive. Outcome measures include disease activity (via JADAS-27), medication changes (escalation or weaning), growth parameter changes (percentile for height, weight, and BMI), and pain. Data collection points are at enrollment, 3 months, and 6 months of the gluten-free diet. Adherence and barriers to adherence were assessed at both follow-up visits. Outcomes were compared using paired t-tests.

Results: 27 patients were enrolled in the trial. 2/27 (7%) screened positive for celiac disease (via tissue transglutaminase IgA) and were excluded from the study. The remainder of the abstract will focus on the remaining 25 patients.

80% are female. Mean age at enrollment is 13.8 years (SD 4.4 years). At baseline, 13 patients (52%) were taking NSAIDs, 11 (44%) were on DMARD therapy, and 8 (32%) were on biologic medications.

To date, 12/25 patients have had their 3-month follow-up visit. Five patients (42%) have voluntarily dis-enrolled due to difficulty with the gluten-free diet. At 3 months, adherence to the diet on a 5-point Likert scale (1 = poor, 5 = perfect) was 3.8 (mean) ± 0.27 (SEM). The majority (83%) cited social situations (such as meals at a restaurant or friend’s home) as the main barrier to adherence. The next most common barrier was cost (17%). No patients chose taste or health effects of the gluten-free diet as barriers.

There have been no significant differences in the patient global assessment score (GAS), physician GAS, and active joint count from the JADAS-27. There has also been no significant difference in patient pain score. Initiation of a gluten-free diet is associated with significantly lower weight and BMI.

Table 1. Characteristics of patients who have completed 3-month follow-up (n=7).

Conclusion: There is no significant difference in disease activity or pain in patients with JIA who trial a gluten-free diet at this interim point. Gluten-free diet might be useful for weight loss; however, pure gluten-free diet is difficult to maintain, as evidenced by our high disenrollment rate. Furthermore, given that 7% of patients screened positive for celiac disease in the absence of any symptoms, there may be utility in screening for celiac disease in patients with newly diagnosed JIA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effects-of-a-gluten-free-diet-in-juvenile-idiopathic-arthritis-a-pilot-study/