Department of Paediatrics, Federal University of Bahia School of Medicine, Brazil.
Clin Exp Rheumatol. 2013 Mar-Apr;31(2):310-7. Epub 2013 Feb 7.
There have been few studies on the association between childhood autoimmune and rheumatic diseases. Therefore, this study aims to assess the frequency of autoimmune thyroiditis (AT), coeliac disease (CD) and type 1 diabetes mellitus (T1DM) in children and adolescents with juvenile idiopathic arthritis (JIA) and rheumatic fever (RF).
This cross-sectional study includes 53 patients with JIA, 66 patients with RF and 40 healthy subjects controls. All subjects were evaluated for thyrotropin (TSH), triiodothyronine (T3), free thyroxine (FT4), antithyroglobulin (Tg) and antiperoxidase antibodies, fasting glucose, C-peptide, anti-glutamic acid decarboxylase (GAD), anti-islet cell (IA) and antitransglutaminase IgA (tTG) antibodies. Patients with thyroid dysfunction, positive anti-thyroid antibodies or tTG underwent thyroid ultrasonography and jejunal biopsy, respectively.
In group 1 (n=53), 21 patients presented thyroid disorders (40%; 42% oligoarticular), either subclinical hypothyroidism (13%) or positive anti-thyroid antibodies (26%, 50% oligoarticular), significantly higher than in control group (p<0.009, OR=10.5, CI 1.29-85.2). In group 2 (n=66), thyroid disorders were identified in 11 patients, four (6%) with subclinical hypothyroidism and seven (11%) with positive anti-thyroid antibodies (p=0.06, compared with the control group). There were no cases of clinical overt hypothyroidism, positive anti-GAD or anti-IA, nor changes in serum C-peptide and glycemia. CD was confirmed in one patient from each group.
Patients with JIA (especially the oligoarticular form) and RF should be investigated for thyroid dysfunction. Longitudinal studies could establish screening protocols for CD in patients with JIA and RF. The cost-effectiveness of T1DM screening is not justified in this population.
儿童自身免疫和风湿性疾病的相关研究较少。因此，本研究旨在评估幼年特发性关节炎（JIA）和风湿热（RF）患儿中自身免疫性甲状腺炎（AT）、乳糜泻（CD）和 1 型糖尿病（T1DM）的发生率。
本横断面研究纳入了 53 例 JIA 患者、66 例 RF 患者和 40 名健康对照者。所有受试者均进行促甲状腺激素（TSH）、三碘甲状腺原氨酸（T3）、游离甲状腺素（FT4）、甲状腺球蛋白（Tg）和过氧化物酶抗体、空腹血糖、C 肽、谷氨酸脱羧酶（GAD）、胰岛细胞（IA）和转谷氨酰胺酶 IgA（tTG）抗体检测。甲状腺功能异常、抗甲状腺抗体阳性或 tTG 阳性的患者分别进行甲状腺超声和空肠活检。
第 1 组（n=53）中有 21 例（40%；42%少关节型）患者存在甲状腺疾病，包括亚临床甲状腺功能减退（13%）或抗甲状腺抗体阳性（26%，50%少关节型），显著高于对照组（p<0.009，OR=10.5，CI 1.29-85.2）。第 2 组（n=66）中发现 11 例甲状腺疾病患者，其中 4 例（6%）为亚临床甲状腺功能减退，7 例（11%）为抗甲状腺抗体阳性（p=0.06，与对照组比较）。无临床显性甲状腺功能减退、抗 GAD 或抗 IA 阳性、血清 C 肽和血糖变化的病例。每组均确诊 1 例 CD。
JIA（尤其是少关节型）和 RF 患儿应进行甲状腺功能检查。纵向研究可确定 JIA 和 RF 患儿 CD 的筛查方案。在该人群中，T1DM 筛查的成本效益并不合理。
