Risk of juvenile idiopathic arthritis and rheumatoid arthritis in patients with celiac disease: A population-based cohort study.

ABSTRACT: METHODSWe identified patients diagnosed with biopsy-proven CD between 2004 to 2017 using data from a national histopathology cohort in Sweden. Each patient was matched by age, sex, calendar year, and geographic region to reference individuals in the general population. We calculated the incidence and estimated the relative risk, via Cox proportional hazards models, of JIA in individuals with CD <18 years of age and of RA in individuals with CD 18 years of age.RESULTSWe identified 24,014 individuals with CD who were matched to 117,397 reference individuals from the general population. Among individuals <18 years of age, the incidence rate of JIA was 5.9 per 10,000 person-years in patients with CD and 2.2 per 10,000 person-years in the general population (n events = 40 and 73, respectively; hazard ratio [HR] 2.68, 95% confidence interval [CI] 1.82-3.95) over a follow-up of 7.0 years. Among individuals 18 years of age, the incidence of RA was 8.4 per 10,000 person-years in CD and 5.1 per 10,000 person-years in matched comparators (n events = 110 and 322, respectively; HR 1.70, 95% CI 1.36-2.12) over a follow-up of 8.8 years.DISCUSSIONAmong children with CD, JIA develops nearly 3 times as often as it does in the general population, and among adults with CD, RA occurs nearly 2 times as often. Clinicians caring for CD patients with joint symptoms should have a low threshold to evaluate for JIA or RA.