Celiac disease and arthritis in Down syndrome

Article Outline

• Copyright

Celiac disease is significantly more common in children with Down syndrome than in the general population, and there has been interest in screening for early diagnosis. In this issue of The Journal, Wouters et al evaluated a method for screening that used HLA-DQ8 typing followed by measurement of IgA-anti-endomysium and anti-tissue transglutaminase antibodies. This approach was quite successful and the authors recommend HLA typing in the first year of life, followed by serological screening of HLA-DQ2- or DQ8-positive children at three years.

In a related article from Juj et al at Children's Hospital, Seattle, children with Down syndrome, in conjunction with juvenile idiopathic arthritis, were identified using the hospital information system. Each case met the diagnostic criteria for juvenile idiopathic arthritis. The cases were compared with cases identified from the medical literature. It was found that the average delay from symptom onset to diagnosis was 2 years and the children presented between 20 months and 12 years. Fifty-seven percent had polyarticular disease, 43% had oligoarticular disease, and many of the latter group progressed to polyarticular arthritis. Most patients required second-line therapy and approximately one half developed joint subluxation. The prevalence of Down syndrome arthropathy was calculated to be 8.7/1000, which is more than six times the incidence of JIA in the general population. Juj et al recommend that pediatricians caring for children with Down syndrome should have a high index of suspicion for symptoms of arthropathy.