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Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever.
Clin Exp Rheumatol 2013 Mar-Apr; 31(2):310-7CE

Abstract

OBJECTIVES

There have been few studies on the association between childhood autoimmune and rheumatic diseases. Therefore, this study aims to assess the frequency of autoimmune thyroiditis (AT), coeliac disease (CD) and type 1 diabetes mellitus (T1DM) in children and adolescents with juvenile idiopathic arthritis (JIA) and rheumatic fever (RF).

METHODS

This cross-sectional study includes 53 patients with JIA, 66 patients with RF and 40 healthy subjects controls. All subjects were evaluated for thyrotropin (TSH), triiodothyronine (T3), free thyroxine (FT4), antithyroglobulin (Tg) and antiperoxidase antibodies, fasting glucose, C-peptide, anti-glutamic acid decarboxylase (GAD), anti-islet cell (IA) and antitransglutaminase IgA (tTG) antibodies. Patients with thyroid dysfunction, positive anti-thyroid antibodies or tTG underwent thyroid ultrasonography and jejunal biopsy, respectively.

RESULTS

In group 1 (n=53), 21 patients presented thyroid disorders (40%; 42% oligoarticular), either subclinical hypothyroidism (13%) or positive anti-thyroid antibodies (26%, 50% oligoarticular), significantly higher than in control group (p<0.009, OR=10.5, CI 1.29-85.2). In group 2 (n=66), thyroid disorders were identified in 11 patients, four (6%) with subclinical hypothyroidism and seven (11%) with positive anti-thyroid antibodies (p=0.06, compared with the control group). There were no cases of clinical overt hypothyroidism, positive anti-GAD or anti-IA, nor changes in serum C-peptide and glycemia. CD was confirmed in one patient from each group.

CONCLUSIONS

Patients with JIA (especially the oligoarticular form) and RF should be investigated for thyroid dysfunction. Longitudinal studies could establish screening protocols for CD in patients with JIA and RF. The cost-effectiveness of T1DM screening is not justified in this population.

Authors+Show Affiliations

Department of Paediatrics, Federal University of Bahia School of Medicine, Brazil. trobazzi@gmail.com

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

23406715

Citation

Robazzi, Teresa C., et al. "Autoimmune Endocrine Disorders and Coeliac Disease in Children and Adolescents With Juvenile Idiopathic Arthritis and Rheumatic Fever." Clinical and Experimental Rheumatology, vol. 31, no. 2, 2013, pp. 310-7.
Robazzi TC, Adan LF, Pimentel K, et al. Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever. Clin Exp Rheumatol. 2013;31(2):310-7.
Robazzi, T. C., Adan, L. F., Pimentel, K., Guimarães, I., Magalhães Filho, J., Toralles, M. B., & Rolim, A. M. (2013). Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever. Clinical and Experimental Rheumatology, 31(2), pp. 310-7.
Robazzi TC, et al. Autoimmune Endocrine Disorders and Coeliac Disease in Children and Adolescents With Juvenile Idiopathic Arthritis and Rheumatic Fever. Clin Exp Rheumatol. 2013;31(2):310-7. PubMed PMID: 23406715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever. AU - Robazzi,Teresa C, AU - Adan,Luis F, AU - Pimentel,Kleber, AU - Guimarães,Isabel, AU - Magalhães Filho,José, AU - Toralles,Maria B, AU - Rolim,Ana M, Y1 - 2013/02/07/ PY - 2012/07/02/received PY - 2012/09/05/accepted PY - 2013/2/15/entrez PY - 2013/2/15/pubmed PY - 2013/6/28/medline SP - 310 EP - 7 JF - Clinical and experimental rheumatology JO - Clin. Exp. Rheumatol. VL - 31 IS - 2 N2 - OBJECTIVES: There have been few studies on the association between childhood autoimmune and rheumatic diseases. Therefore, this study aims to assess the frequency of autoimmune thyroiditis (AT), coeliac disease (CD) and type 1 diabetes mellitus (T1DM) in children and adolescents with juvenile idiopathic arthritis (JIA) and rheumatic fever (RF). METHODS: This cross-sectional study includes 53 patients with JIA, 66 patients with RF and 40 healthy subjects controls. All subjects were evaluated for thyrotropin (TSH), triiodothyronine (T3), free thyroxine (FT4), antithyroglobulin (Tg) and antiperoxidase antibodies, fasting glucose, C-peptide, anti-glutamic acid decarboxylase (GAD), anti-islet cell (IA) and antitransglutaminase IgA (tTG) antibodies. Patients with thyroid dysfunction, positive anti-thyroid antibodies or tTG underwent thyroid ultrasonography and jejunal biopsy, respectively. RESULTS: In group 1 (n=53), 21 patients presented thyroid disorders (40%; 42% oligoarticular), either subclinical hypothyroidism (13%) or positive anti-thyroid antibodies (26%, 50% oligoarticular), significantly higher than in control group (p<0.009, OR=10.5, CI 1.29-85.2). In group 2 (n=66), thyroid disorders were identified in 11 patients, four (6%) with subclinical hypothyroidism and seven (11%) with positive anti-thyroid antibodies (p=0.06, compared with the control group). There were no cases of clinical overt hypothyroidism, positive anti-GAD or anti-IA, nor changes in serum C-peptide and glycemia. CD was confirmed in one patient from each group. CONCLUSIONS: Patients with JIA (especially the oligoarticular form) and RF should be investigated for thyroid dysfunction. Longitudinal studies could establish screening protocols for CD in patients with JIA and RF. The cost-effectiveness of T1DM screening is not justified in this population. SN - 0392-856X UR - https://www.unboundmedicine.com/medline/citation/23406715/Autoimmune_endocrine_disorders_and_coeliac_disease_in_children_and_adolescents_with_juvenile_idiopathic_arthritis_and_rheumatic_fever_ L2 - http://www.clinexprheumatol.org/pubmed/find-pii.asp?pii=23406715 DB - PRIME DP - Unbound Medicine ER -