Recurrent monoarthritis in an 11-year-old boy with occult coeliac disease.Successful and stable remission after gluten-free diet

A case of occult coeliac disease (CD) presenting with recurrent monoarthrit is in a boy aged 11 years is reported. The case is unique due to the associ ation of occult untreated CD and arthritis in childhood. Peripheral or axia l arthritis as a first manifestation of occult CD has been described in adu lt patients, with an interval between the arthritis and CD of up to 15 year s. In our case the interval between the appearance of arthritis and the dia gnosis of CD was 2 years. The boy was asymptomatic for bowel disease and hi s nutritional status was normal. The diagnosis of CD was established using anti-gliadin (AGA) and anti-endomysium (EMA) antibody tests and was confirm ed by small bowel biopsy. The introduction of a gluten-free diet resulted i n the persistent remission of arthritis. As the treatment of CD-associated arthritis is based on dietary therapy, physicians should be alert to the po ssibility of occult CD in any child with arthritis of unclear origin.