title: Unrecognized Celiac Disease in Children Presenting for Rheumatology Evaluation.
abstract: OBJECTIVE
  Current clinical guidelines do not consider patients with rheumatic conditions to be at high risk for celiac disease (CD) despite numerous reported associations between the two in adults and children. The objective of this study was to evaluate the prevalence of CD among patients presenting for pediatric rheumatology evaluation.
  
  
  METHODS
  A total of 2125 patients presenting for initial evaluation by the Division of Pediatric Rheumatology at the Hospital for Special Surgery between June 2006 and December 2013 were screened for CD as a part of the standard initial serologic evaluation. The charts of these patients were evaluated retrospectively at the end of this period.
  
  
  RESULTS
  36 patients (30 girls, 6 boys, mean age 9.4 ± 4.3 years, range 2-16 years) received a diagnosis of CD after serologic testing and evaluation by pediatric gastroenterology. Eight additional patients with known diagnoses of CD presented during this time period. The total prevalence of CD over this 6.5-year period was 2.0%. The most common presenting complaints among patients diagnosed with CD were myalgias, arthralgias, and rash. Less frequently, patients reported gastrointestinal complaints including abdominal pain, nausea, and diarrhea. All patients reported improvement or complete resolution of their musculoskeletal symptoms after initiation of a gluten-free diet.
  
  
  CONCLUSIONS
  This study identified 36 new cases of CD among children presenting for rheumatology evaluation, for an overall prevalence rate of 2.0%. The majority of patients who ultimately received a diagnosis of CD presented with extraintestinal manifestations. These results underscore the importance of screening children presenting for rheumatology evaluation for CD.
authors.affiliation: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
authors.forename: Yekaterina
authors.initials: Y
authors.lastname: Sherman
authors.affiliation: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
authors.forename: Rose
authors.initials: R
authors.lastname: Karanicolas
authors.affiliation: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
authors.forename: Brittany
authors.initials: B
authors.lastname: DiMarco
authors.affiliation: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
authors.forename: Nancy
authors.initials: N
authors.lastname: Pan
authors.affiliation: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York;
authors.forename: Alexa B
authors.initials: AB
authors.lastname: Adams
authors.affiliation: Division of Rheumatology, Mount Sinai Medical Center, New York, New York; and.
authors.forename: Laura V
authors.initials: LV
authors.lastname: Barinstein
authors.affiliation: Division of Pediatric Rheumatology, Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: L Nandini
authors.initials: LN
authors.lastname: Moorthy
authors.affiliation: Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York; goldscout@aol.com.
authors.forename: Thomas J A
authors.initials: TJ
authors.lastname: Lehman
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D055050:Diet, Gluten-Free / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis*; D012698:Serologic Tests; D013997:Time Factors