Subclinical synovitis detected by ultrasound in children affected by coeliac disease: a frequent manifestation improved by a gluten-free diet.
OBJECTIVE
Coeliac disease (CD) is a chronic autoimmune disease of the small intestine caused by the ingestion of gluten, in which musculoskeletal manifestations may occur. Aim of this study was to evaluate the prevalence and severity of joint involvement in paediatric patients with CD using musculoskeletal ultrasound (US).


METHODS
Consecutive paediatric CD patients were enrolled and underwent US evaluations at level of knees, hips and ankles. The presence of joint effusion (JE), synovial hypertrophy, power Doppler signal and structural damage lesions (bone irregularities and erosions) was registered. Inflammatory abnormalities were scored on a semi-quantitative scale (0-3), and structural damage lesions on a dichotomous scale (0-1).


RESULTS
Seventy-four CD children (mean age: 7.6 years; range: 1-14.2; M/F 24/50) were enrolled. Thirty-eight were on a gluten-containing diet (GCD) and 36 on a gluten-free diet (GFD). US showed the presence of abnormalities in 23 patients overall (31.1%); JE was the most frequently observed change (23/23). US abnormalities were observed in 19 patients (50.0%) of GCD group and in 4 of GFD group (11.1%, p=0.007). Interestingly, 12/23 (52.2%) patients with US-detected changes were asymptomatic.


CONCLUSIONS
This is the first US study demonstrating joint involvement in children with CD. JE, the most frequent manifestation, was present also in asymptomatic patients and was reduced in those on GFD. These findings may indicate that, also at joint level, an inflammatory response represented by the appearance of JE may be induced by exposure to gluten.
Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Roma, Italy. annamaria.iagnocco@uniroma1.it.
Annamaria
A
Iagnocco
Fulvia
F
Ceccarelli
Maurizio
M
Mennini
Iolanda Maria
IM
Rutigliano
Carlo
C
Perricone
Raffaella
R
Nenna
Laura
L
Petrarca
Gerarda
G
Mastrogiorgio
Guido
G
Valesini
Margherita
M
Bonamico
D000293:Adolescent; D058070:Asymptomatic Diseases; D002446:Celiac Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000178:diet therapy*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D007223:Infant; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000209:etiology; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler