Rheumatic Symptoms

Celiac disease affects at least 1 in 133 people in the United States — many of them children.

About 300,000 children in the U.S. live with juvenile arthritis.

Now, there may be a connection.

Children with rheumatic symptoms such as joint pain, joint swelling, or mixed connective tissue problems should be screened for celiac disease (CD).

That’s the recommendation in a new study published in the journal Pediatrics.

Researchers from the Division of Pediatric Rheumatology at the Hospital for Special Surgery, in New York (HSSNY) as well as the Division of Rheumatology at Mount Sinai Medical Center in New York and the Division of Pediatric Rheumatology at Robert Wood Johnson Medical School in New Jersey, spent seven years investigating a possible connection between the presentation of pediatric joint pain and childhood celiac disease. 

Get the Facts: What Is Rheumatoid Arthritis? »

Childhood Joint Pain and Celiac

Between June 2006 and December 2013, the team of researchers studied 2,125 patients aged 2 to 16 who were treated at the HSSNY Division of Rheumatology.

Of these, 36 were suspected of having “silent” celiac disease (no gastrointestinal symptoms). Thirty of these 36 had suspicions of celiac confirmed via blood tests and endoscopy. Twenty-two of these patients presented with musculoskeletal pain alone and none of the classic gastrointestinal symptoms of celiac. Only 12 of the patients reported stomach or intestinal symptoms, proving how wide-ranging the list of possible celiac symptoms can be.

Gluten

Currently, neither the American College of Gastroenterology nor the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consider juvenile arthritis patients or kids presenting with joint problems or musculoskeletal pain to be a high-risk group.

Researchers on this study want that to change.

They stated, “Our data suggest that there may be a subset of patients with ‘silent’ CD who present with isolated musculoskeletal symptoms and that perhaps [juvenile idiopathic arthritis] is not an appropriate diagnosis in these cases. Clinicians must be vigilant in cases such as these to evaluate appropriately for CD.”

Get the Facts on Celiac Disease »

What Do Experts Think?

According to the Hospital for Special Surgery, New York, “People with celiac disease are more likely to have autoimmune disorders like rheumatoid arthritis or lupus, but the exact relationship is still under investigation.”

Dr. Margalit Rosenkranz, a pediatric rheumatologist from the Division of Pediatric Rheumatology at the Children's Hospital of Pittsburgh, agrees.

She told Healthline, “Celiac disease is an under-diagnosed disease and there are some who present with joint pains and not abdominal complaints. There is a known association between celiac disease and joint pain or actual joint arthritis. Typically, these patients already have a diagnosis of celiac disease and then they develop symptoms in their joints or muscles.”

Rosenkranz added that a gluten-free diet — the only treatment for celiac disease — is not always a foolproof way to quell joint pain.

She said, “In those who have joint pain associated with celiac disease, some kids may respond to a gluten-free diet, but it is not clear whether eliminating gluten always treats the joint pain.”

She acknowledged the value in investigating the link further and potentially screening children with joint pain for celiac disease. 

“Screening for celiac antibodies in all kids with joint pain or joint swelling is not routinely done, but as is shown by the recent study at [the] Hospital for Special Surgery, it may be worth screening all these children for celiac disease,” said Rosenkranz.

The Arthritis Foundation acknowledges that going gluten-free for arthritis may be beneficial, but many of their experts state that it isn’t proven to work quite yet.

Nonetheless, the authors of the study argue that the results highlight how important it is to nonetheless do a celiac screening on children presenting for a rheumatology evaluation.

Read More: Is Non-Celiac Gluten Sensitivity a Real Thing? »