Celiac disease with atypical symptoms or celiac disease with juvenile chronic arthritis – case report

The complains of the seven year old boy started about two years ago with relepsing fevers, with non specific pain and joint swelling of the lower extremities, and with starting anaemia.

The boy went on different examinations in different hospitals, where they have diagnosed juvenile chronic arthritis, and started steroid therapy.

On the steroid treatment, the patient's symptoms disappeared, all but the anemia from iron deficiency. But every time they have tried to end the immunosuppressive therapy, all the pain, the fever and tiredness came back.

The little boy came to our clinic at that point. We have extended the immunological examinations, which showed elevated tissue transglutaminase level, and positivity of the endomysium antibody. Because of the serological results, we have done small bowel biopsy. The histological investigation showed specific signs of celiac disease. Because of the result, we have started gluten free diet with followed NSAID therapy.

Without the steroid therapy, being on the gluten free diet, the patients rheumatic complains disappeared, and they didn't came back anymore.

After the starting the diet, the results of the control serological tests get better. Because of that, we have decided to stop the NSAID therapy as well, wich was successful.

The young boy is on gluten free diet since about 10 month, and he doesn't have any complain. His laboratory results have normalized.

It's known from the literature, that rheumatic arthritis is sometimes associated with enteropathy, and in some cases the complains of the arthropathy are decreasing on glutenfree diet, although clinicians and pathologist can't confirm celiac disease even with histological examinations.

In our patient to prove, that the juvenile chronic arthritis is not associated with celiac disease, we have to follow-up the boy closely in the future.