Celiac disease complicated with JRA
The A.M 8.4 y old male child diagnosed to have celiac disease on 2/2011 based on Duodenal Biopsy, and positive HLA DQ2 and 10, with negative celiac screen but low IgA level.
Patient used to have diarrhea with abdominal distention, and anemia with poor wt. gain these complains since 5 y which resolved by gluten free diet which started on 6/2/2013, till now.
After gluten free diet there is no diarrhea no abdominal distention or pain and no vomiting.
Duodenal Biopsy done on 2/2011 shown: Total villous Atrophy Crypts hyperplasia, increased intraepithelial lymphocytes, compatible with MARCH 11 C,Colon Focal Colitis, HLA DQ 2/HLA DQ8 positive.
Investigations was done at that time:
· IgA 16, IgM 98, IgG 3377, Anti Ttga neg,AGA 16,2 Anti EAb 0,2 occult blood and analysis normal, blood film normal.
· On 6/2/2013 was readmitted in hospital to do GI Endoscopy to take second biopsy for control for gluten free diet and biopsy showed normal gross findings.
· Specific Investigations, Echo,ECG,EEG, EMU, Ophth.
Development and feeding history
Gross Motor / Up to ageFine Motor / Up to age
Social / Up to age
Speech / Up to age
School performance up to age, 3grade with good school performance
After One y of confirmed Diagnoses of celiac disease patient developed arthritis and athralgia of his rt.wrist, 1 st right PIP and DIP, both knees and left ankle which diagnosed to have JRA.
These joints were injected with THA ( Triancinolone Hexacetonide ).
Physical Examination
On examination will appearing but with multiarticolar joint pain and arthritis.
Legnth 129 cm, Wt, 29 kg on third percentile.
Follow up after 3 weeks of injection of THA intraarticular by pediatric rheumatologist impression there is improvement in knees, still active disease involving R wrist hand and L ankle.
Recommend
1- Begin methotrexat 12.5 mg subcutaneously once weekly.
2- Folic acid 5 mg orally, on the day following methotrexate.
Conclusion:
Celiac disease complicated and JRA with Deformity.