Background/Purpose:

There are multiple strong associations between gut pathology and rheumatologic diseases. This connection, between primary GI disease and rheumatologic diseases, is manifest in both autoimmune and infectious GI diseases.  For example, arthritis is a component of several GI infections (Reactive arthritis following Salmonella, Shigella, Yersinia, or Campylobacter species, Whipples disease, and multiple parasitic infections) as well as inflammatory bowel disease and behcet’s.  Arthritis is also a known extra-intestinal manifestation of celiac disease.  There is controversy regarding the prevalence of celiac in adult arthritis and to date only a few small studies exist in children.  Additionally, both in children and adults, little is known regarding possible association of food allergies and arthritis.  With this study, we endeavored to assess the risk of food allergy and celiac disease in a large population of children with juvenile idiopathic arthritis (JIA)  

Methods:

We analyzed electronic medical records from Boston Children’s Hospital, between the years 1993 and 2014. Children with JIA, food allergy and celiac disease were identified, using tools of the National Center for Biomedical Computing “Informatics for Integrating Biology to the Bedside” (i2b2). We assessed the risk of food allergy and celiac disease in JIA patients, in comparison with the children without JIA.

Results:

A total of 1,933,719 children were included in our study. Of this total population 0.21% (n=4,128) had documented JIA, 1.14% had food allergy, and 0.18% had celiac disease (Table 1). Of the subjects with JIA 1.99% had documented food allergy and 1.02% had celiac disease. Children with JIA had an elevated risk of developing food allergy (OR 1.75; 95% CI 1.41 – 2.18; p<0.0001), and celiac disease (OR 5.58; 95% CI 4.11 – 7.58; p<0.0001).

Table 1.

Disease	Number of patients (%)
Study population (n=1,933,719)
JIA	4,128 (0.21)
Food allergy	21,953 (1.14)
Celiac disease	3,559 (0.18)
JIA population (n=4,128)
Food allergy	82 (1.99)
Celiac disease	42 (1.02)

Conclusion:

We again find evidence of an association between the gut and rheumatologic disease.  We clearly demonstrate an increased risk of celiac in JIA, consistent with the limited data on the subject.  We also find a statistically significant increased risk of food allergies in JIA.  In celiac evidence supports improvement or resolution of the associated arthritis with the removal of the trigger food, gluten.  We do not yet know if the same holds true for food allergies.  It is possible food allergies can exacerbate JIA but further work must be done to answer this question.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/food-allergy-and-celiac-disease-in-children-with-juvenile-idiopathic-arthritis/