title: Association of systemic-onset juvenile idiopathic arthritis and celiac disease - a case report.
abstract: BACKGROUND
  In a 28-year period, 5508 patients were followed at our Paediatric Rheumatology Division and 712 (13%) patients had juvenile idiopathic arthritis (JIA) (ILAR criteria). One (0.14%) of them had association with celiac disease (CD), with predominance of gastrointestinal manifestations and this case was described herein.
  
  
  METHODS
  A 10-years-old female patient was hospitalized with persistent fever, weight loss, asthenia, anorexia and an evanescent pink macular rash. After one week, she presented arthritis of left knee and ankle with duration of 75 days. The initial laboratory exams revealed anemia and elevation of inflammatory markers. Immunological tests were positive for anti-endomysial antibodies IgA and anti-thyroglobulin antibody. The diagnosis of systemic JIA was established and indomethacin (2.0 mg/kg/day) was started with improvement of arthritis. The patient evolved with vomiting, diarrhea and abdominal pain and upper gastrointestinal barium study showed areas of small bowel dilatation and thickening of folds, suggestive of malabsorption syndrome. Colonoscopy was normal and small intestinal biopsy was compatible with CD.
  
  
  CONCLUSIONS
  We reported a case of a rare association of early diagnosis of systemic JIA occurring simultaneously with CD. This study reinforces the importance of taking into account the possible association of organ-specific autoimmune diseases during JIA course.
authors.affiliation: Pediatric Rheumatology Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Cintia Maria
authors.initials: CM
authors.lastname: Michelin
authors.forename: Nadia Emi
authors.initials: NE
authors.lastname: Aikawa
authors.forename: João Carlos
authors.initials: JC
authors.lastname: Diniz
authors.forename: Adriana Almeida
authors.initials: AA
authors.lastname: Jesus
authors.forename: Yu Kar
authors.initials: YK
authors.lastname: Koda
authors.forename: Clovis Artur
authors.initials: CA
authors.lastname: Silva
mesh_terms: D001171:Arthritis, Juvenile / Q000150:complications*; D002446:Celiac Disease / Q000150:complications*; D002648:Child; D005260:Female; D006801:Humans