1
|
Sapountzi E, Tsinopoulou VR, Kotanidou EP, Giza S, Galli-Tsinopoulou A. Coexistence of Autoimmune Thyroiditis and Juvenile Idiopathic Arthritis. Cureus 2023; 15:e44384. [PMID: 37654906 PMCID: PMC10467609 DOI: 10.7759/cureus.44384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE Autoimmune thyroid disease seems to occur more often in children with juvenile idiopathic arthritis (JIA) than in the general pediatric population. We investigated the prevalence of autoimmune thyroiditis (Hashimoto's thyroiditis) in young patients with JIA in Greece, which has not been evaluated previously. METHODS This descriptive study included patients with JIA followed up at the Pediatric Rheumatology Unit of the Second Department of Pediatrics of a tertiary general hospital in Thessaloniki, Greece. All patients were diagnosed and sorted according to the classification criteria of the International League of Associations for Rheumatology. The presence of thyroid autoantibodies was considered for determining autoimmune thyroiditis. Basic demographic, clinical, and laboratory data were collected from patients' records. Results: The analyzed sample comprised 130 patients with JIA (mean age 12.22 years; 69.2% female). Most patients (70%) had a family history of at least one autoimmune disease and 30.8% of Hashimoto's thyroiditis. More than half (53.8%) had enthesitis-related arthritis (ERA), 22.3% had oligoarthritis, and 15.4% had psoriatic arthritis. Thyroid autoantibodies were detected in 22/130 patients (16.9%) suggesting autoimmune thyroiditis; most of these patients were euthyroid, whereas 3/22 (13.6%) had overt hypothyroidism determined by elevated levels of thyroid-stimulating hormone, decreased levels of free thyroxine, and typical ultrasound findings for Hashimoto's thyroiditis. The prevalence of clinical cases of Hashimoto's disease was 2.3%. CONCLUSIONS The prevalence of autoimmune thyroiditis in our JIA cohort is higher compared to the general population and consistent with the previously reported range. Hence, investigation for thyroid autoimmunity should be included in the workup of patients with JIA.
Collapse
Affiliation(s)
- Evdoxia Sapountzi
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, GRC
| | - Vasiliki-Rengina Tsinopoulou
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, GRC
| | - Eleni P Kotanidou
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, GRC
| | - Styliani Giza
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, GRC
| | - Assimina Galli-Tsinopoulou
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, GRC
| |
Collapse
|
2
|
Bansal N, Pasricha C, Kumari P, Jangra S, Kuar R, Singh R. A comprehensive overview of juvenile idiopathic arthritis: From pathophysiology to management. Autoimmun Rev 2023; 22:103337. [PMID: 37068698 DOI: 10.1016/j.autrev.2023.103337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/13/2023] [Indexed: 04/19/2023]
Abstract
Rheumatoid Arthritis (RA) is a progressive autoimmune disease. It is among the most widespread chronic illnesses in children, with an annual incidence of 1.6 to 23 new instances per 100,000 adolescents. About 1 child in every 1000 develops Juvenile Idiopathic Arthritis (JIA) type of chronic arthritis. The cause of JIA is not well known but what known is that it involves inflammation of the synovium and destruction of tissues in joints which can cause early-onset of oligo articular JIA. It is challenging to diagnose the condition in some children who initially complain of pain and joint swelling as there is no blood test discovered that can confirm the diagnoses of JIA. As JIA patients are immunosuppressed due to the use of drugs, making them vulnerable to catch infections like COVID 19 which can lead to cardiovascular diseases having high rate of morbidity and mortality. The comorbidity like Diabetes has higher incidence in these patients resulting in synergistic effect on inflammation. Currently, the connection of genetics in JIA provides evidence that HLA Class I and II alleles have a role in the pathophysiology of various subtypes of JIA which includes inflammation in the axial skeletal. The primary objective of therapy in juvenile idiopathic arthritis is the suppression of clinical symptoms. The pharmacological approach includes use of medications like DMARDs, NSAIDs etc. and non-pharmacological approach includes physiotherapy, which helps in restoring normal joint function and herbs as adjuvants which has the benefit of no side effects.
Collapse
Affiliation(s)
- Nancy Bansal
- Chitkara College of Pharmacy, Chitakara University, Punjab, India
| | - Chirag Pasricha
- Chitkara College of Pharmacy, Chitakara University, Punjab, India
| | - Pratima Kumari
- Chitkara College of Pharmacy, Chitakara University, Punjab, India
| | - Sarita Jangra
- Chitkara College of Pharmacy, Chitakara University, Punjab, India
| | - Rupinder Kuar
- Chitkara College of Pharmacy, Chitakara University, Punjab, India
| | - Ravinder Singh
- Chitkara College of Pharmacy, Chitakara University, Punjab, India.
| |
Collapse
|
3
|
Betterle C, Furmaniak J, Sabbadin C, Scaroni C, Presotto F. Type 3 autoimmune polyglandular syndrome (APS-3) or type 3 multiple autoimmune syndrome (MAS-3): an expanding galaxy. J Endocrinol Invest 2023; 46:643-665. [PMID: 36609775 DOI: 10.1007/s40618-022-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The number of recognised distinct autoimmune diseases (AIDs) has progressively increased over the years with more than 100 being reported today. The natural history of AIDs is characterized by progression from latent and subclinical to clinical stages and is associated with the presence of the specific circulating autoantibodies. Once presented, AIDs are generally chronic conditions. AIDs have the tendency to cluster and co-occur in a single patient. Autoimmune thyroid diseases (AITD) are the most prevalent of AIDs in the world population, and about one-third of the AITD patients also present with a non-thyroid AID during their life-span. Furthermore, patient with non-thyroid AIDs often presents with a form of AITD as a concurrent condition. Many of the clusters of AIDs are well characterized as distinctive syndromes, while some are infrequent and only described in case reports. PURPOSE In this review, we describe the wide spectrum of the combinations and the intricate relationships between AITD and the other AIDs, excluding Addison's disease. These combinations are collectively termed type 3 Autoimmune Polyglandular Syndrome (APS-3), also called type 3 Multiple Autoimmune Syndrome (MAS-3), and represent the most frequent APS in the world populations. CONCLUSIONS Numerous associations of AITD with various AIDs could be viewed as if the other AIDs were gravitating like satellites around AITD located in the center of a progressively expanding galaxy of autoimmunity.
Collapse
Affiliation(s)
- C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
- Chair of Clinical Immunology and Allergy, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale Civile 105, 35128, Padua, Italy.
| | | | - C Sabbadin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - C Scaroni
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - F Presotto
- Unit of Internal Medicine, Ospedale Dell'Angelo, Mestre-Venice, Italy
| |
Collapse
|
4
|
van Straalen JW, Baas L, Giancane G, Grebenkina L, Brunner J, Vega-Cornejo G, Chasnyk VG, Harel L, Appenzeller S, Gervais E, de Roock S, Wulffraat NM, Ruperto N, Swart JF. Juvenile idiopathic arthritis patients with positive family history of autoimmune thyroid disease might benefit from serological screening: analysis of the international Pharmachild registry. Pediatr Rheumatol Online J 2023; 21:19. [PMID: 36810111 PMCID: PMC9945712 DOI: 10.1186/s12969-023-00802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Little is known about the association between juvenile idiopathic arthritis (JIA) and autoimmune thyroid disease (AITD) and therefore there are no indications for AITD screening in this population, which is possible using standard blood tests. The objective of this study is to determine the prevalence and predictors of symptomatic AITD in JIA patients from the international Pharmachild registry. METHODS Occurrence of AITD was determined from adverse event forms and comorbidity reports. Associated factors and independent predictors for AITD were determined using univariable and multivariable logistic regression analyses. RESULTS The prevalence of AITD after a median observation period of 5.5 years was 1.1% (96/8965 patients). Patients who developed AITD were more often female (83.3% vs. 68.0%), RF positive (10.0% vs. 4.3%) and ANA positive (55.7% vs. 41.5%) than patients who did not. AITD patients were furthermore older at JIA onset (median 7.8 years vs. 5.3 years) and had more often polyarthritis (40.6% vs. 30.4%) and a family history of AITD (27.5% vs. 4.8%) compared to non-AITD patients. A family history of AITD (OR = 6.8, 95% CI: 4.1 - 11.1), female sex (OR = 2.2, 95% CI: 1.3 - 4.3), ANA positivity (OR = 2.0, 95% CI: 1.3 - 3.2) and older age at JIA onset (OR = 1.1, 95% CI: 1.1 - 1.2) were independent predictors of AITD on multivariable analysis. Based on our data, 16 female ANA positive JIA patients with a family history of AITD would have to be screened during ±5.5 years using standard blood tests to detect one case of AITD. CONCLUSIONS This is the first study to report independent predictor variables for symptomatic AITD in JIA. Female ANA positive JIA patients with positive family history are at increased risk of developing AITD and thus might benefit from yearly serological screening.
Collapse
Affiliation(s)
- Joeri W. van Straalen
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Laurie Baas
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Gabriella Giancane
- grid.419504.d0000 0004 1760 0109Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Lyudmila Grebenkina
- Pediatric Department, Togliatti City Clinical Hospital №5, Togliatti, Russia
| | - Jurgen Brunner
- grid.5361.10000 0000 8853 2677Pediatric Rheumatology, Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria ,grid.465811.f0000 0004 4904 7440Danube Private University, Krems, Austria
| | - Gabriel Vega-Cornejo
- Clínica Pediátrica de Reumatología y Enfermedades Autoinmunes (CREA), Hospital México Americano, Guadalajara, Mexico
| | - Vyacheslav G. Chasnyk
- grid.445931.e0000 0004 0471 4078Department of Hospital Pediatrics, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Liora Harel
- grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center, Petach-Tikvah, Israel ,grid.12136.370000 0004 1937 0546Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simone Appenzeller
- grid.411087.b0000 0001 0723 2494Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Elisabeth Gervais
- grid.411162.10000 0000 9336 4276Rheumatology, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Sytze de Roock
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109UOSID Centro trial, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | | |
Collapse
|
5
|
Lovell DJ, Huang B, Chen C, Angeles-Han ST, Simon TA, Brunner HI. Prevalence of autoimmune diseases and other associated conditions in children and young adults with juvenile idiopathic arthritis. RMD Open 2021; 7:rmdopen-2020-001435. [PMID: 33731444 PMCID: PMC7978075 DOI: 10.1136/rmdopen-2020-001435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Many autoimmune diseases share common pathogenic mechanisms; however, there are limited studies quantifying the coexistence of autoimmune diseases and associated conditions in patients with juvenile idiopathic arthritis (JIA). This large US-based study estimated and compared the prevalence of multiple coexisting autoimmune diseases in patients with JIA with a general paediatric (GP) patient population. Methods This retrospective cohort study was conducted using registry data from the Cincinnati Children’s Hospital Medical Center (January 2010–October 2018). The prevalence of multiple autoimmune diseases was estimated in patients (age <21 years) with JIA and a control group from the GP patient population. Crude prevalences of 26 prespecified autoimmune diseases and associated conditions were compared using Bayesian Poisson regression modelling for each year up to the end of the study period. Results Overall, 2026 patients were included in the JIA cohort and 41 572 in the GP cohort. Of 26 autoimmune diseases and associated conditions evaluated, 14 (53.8%) had a significantly higher prevalence in the JIA cohort compared with the GP cohort. In total, seven (26.9%) autoimmune diseases or associated conditions had a >20-fold increased prevalence in the JIA cohort compared with the GP cohort. Conclusion In this study, patients with JIA had a greater prevalence of a large number of coexisting autoimmune diseases and associated conditions compared with the GP population. Physicians should consider coexisting autoimmune diseases in the treatment and management of patients with JIA.
Collapse
Affiliation(s)
- Daniel J Lovell
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chen Chen
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sheila T Angeles-Han
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Teresa A Simon
- Bristol Myers Squibb, Princeton, New Jersey, USA.,Physicians Research Center, LLC, Toms Rover, New Jersey, USA
| | - Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
6
|
Simon TA, Harikrishnan GP, Kawabata H, Singhal S, Brunner HI, Lovell DJ. Prevalence of co-existing autoimmune disease in juvenile idiopathic arthritis: a cross-sectional study. Pediatr Rheumatol Online J 2020; 18:43. [PMID: 32503658 PMCID: PMC7275412 DOI: 10.1186/s12969-020-00426-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Many autoimmune diseases share common pathogenic mechanisms, cytokine pathways and systemic inflammatory cascades; however, large studies quantifying the co-existence of autoimmune diseases in patients with juvenile idiopathic arthritis (JIA) have not been conducted. METHODS We performed a cross-sectional study using two United States administrative healthcare claims databases (Truven Health MarketScan® Commercial Database and IMS PharMetrics database) to screen for the prevalence of multiple autoimmune diseases in patients with JIA and in a control group with attention deficit hyperactivity disorder (ADHD). Patients with a diagnosis code for JIA or ADHD between January 1, 2006 and September 30, 2017 were separated into two age cohorts (< 18 and ≥ 18 years) and matched (maximum 1:5) based on age, sex, number of medical encounters, and calendar year of diagnosis. The prevalence rates of 30 pre-specified autoimmune diseases during the 12-month periods before and after diagnosis were compared. RESULTS Overall, 29,215 patients with JIA and 134,625 matched control patients with ADHD were evaluated. Among patients in the MarketScan database, 28/30 autoimmune diseases were more prevalent in patients with JIA aged < 18 years and 29/30 were more prevalent in patients aged ≥ 18 years when compared with a matched cohort of patients with ADHD. In the PharMetrics database, 29/30 and 30/30 autoimmune diseases were more prevalent in patients with JIA aged < 18 and ≥ 18 years, respectively, compared with a matched cohort of patients with ADHD. Among patients with JIA aged < 18 years, the greatest odds ratios (ORs) were seen for Sjögren's syndrome/sicca syndrome and uveitis. Among patients aged ≥ 18 years in the MarketScan database, the greatest ORs were recorded for uveitis. Data from the PharMetrics database indicated that the greatest ORs were for uveitis and chronic glomerulonephritis. CONCLUSIONS Patients with JIA are more likely to have concurrent autoimmune diseases than matched patients with ADHD. Having an awareness of the co-existence of autoimmune diseases among patients with JIA may play an important role in patient management, treatment decisions, and outcomes. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
| | | | | | | | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
7
|
Systemic lupus erythematosus and thyroid disease – Experience in a single medical center in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:480-486. [DOI: 10.1016/j.jmii.2016.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 10/12/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022]
|
8
|
Malagón C, Gomez MDP, Mosquera C, Vargas C, Gonzalez T, Arango C, Martin L, Perez P, Amaya-Uribe L, Molano-Gonzalez N, Anaya JM. Juvenile polyautoimmunity in a rheumatology setting. Autoimmun Rev 2019; 18:369-381. [DOI: 10.1016/j.autrev.2018.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
|
9
|
Tronconi E, Miniaci A, Pession A. The autoimmune burden in juvenile idiopathic arthritis. Ital J Pediatr 2017; 43:56. [PMID: 28615030 PMCID: PMC5471888 DOI: 10.1186/s13052-017-0373-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is a chronic inflammatory arthritis of unknown origin which can be considered an autoimmune disease (AD). The aim of this study is to analyse the presence of two or more autoimmune diseases (polyautoimmunity) in patients suffering from JIA and to evaluate the occurrence of ADs in their families. Methods Seventy-nine patients diagnosed with JIA aged 0–21 years, admitted to the Paediatric Rheumatology Unit, Sant’Orsola-Malpighi Hospital, Bologna were screened for ADs. Parents were asked about the presence of ADs in the living relatives of first and second degree. Results Twelve of 79 patients (15.2%) had at least 1 AD associated with JIA. Eight patients (10.1%) suffered from autoimmune thyroid disease (AITD), three patients had celiac disease, three patients suffered from psoriasis, one from alopecia and 1 from insulin-dependent diabetes mellitus. The average age at diagnosis was 13.2 years and the cumulative incidence of AITD was 36%. Seventy-six families were studied for a total of 438 relatives. The prevalence of ADs was 13%, greater in first-degree relatives (16.7%) than in second-degree ones (11.1%). The most common AD was AITD; there was no difference in JIA’s age of presentation between patients with positive and negative familiarity with ADs (p > 0.05). Conclusion Children and adolescents with JIA present a high autoimmunity burden, most commonly represented by AITD. Familial autoimmunity is not negligible in patients suffering from JIA (almost 50% of patients have at least one relative with an AD) and it should always be carefully examined.
Collapse
Affiliation(s)
- Elena Tronconi
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy. .,Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
| | - Angela Miniaci
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
10
|
Abstract
OBJECTIVE The aim of this study was to report the frequency of autoimmune disorders and autoantibodies in 22 patients with neuromyelitis optica (NMO), as well as whether the seropositivity for autoantibodies differs between anti-aquaporin 4 (AQP4) positive and AQP4 negative NMO patients. METHODS Demographic, medical records, and a profile of autoantibodies were evaluated in 22 NMO patients, including AQP4, anti-thyroid-stimulating hormone receptor, antinuclear antibodies (ANA), anti-thyroperoxidase (anti-TPO), anti-thyroglobulin (anti-Tg), anti-double-stranded DNA, anti-neutrophil cytoplasmic, anti-cyclic citrullinate peptide, rheumatoid factor, anti-SSA/Ro, anti-SSB/La, anti-Smith antibodies (anti-Sm), anti-ribonucleoprotein, anti-nucleosome, and anti-Scl70. Thyroid-stimulating hormone and free thyroxin were measured. RESULTS The frequency of women was higher than men (95.5% vs. 4.5%) and 68.2% were Afro-Brazilians. Six (27.3%) patients presented other autoimmune disorders, such as Hashimoto thyroiditis (n=2), Graves' disease (n=1), juvenile idiopathic arthritis (n=1), systemic lupus erythematosus and systemic sclerosis (n=1), and Raynaud's phenomenon (n=1). The most frequent autoantibodies were anti-AQP4 (54.5%), anti-nucleosome (31.8%), ANA (27.3%), anti-TPO (22.7%), and anti-Tg (22.7%). Difference was not observed in the frequency of autoimmune disorders when the patients were compared according to their anti-AQP4 status. CONCLUSION The results of the present study underscored that the NMO patients present high frequency of autoantibodies against cellular antigens and the presence of autoimmune disorders. Further studies with large number of NMO patients may contribute to advances in the understanding of NMO disease mechanisms.
Collapse
|
11
|
Ferrari SM, Elia G, Virili C, Centanni M, Antonelli A, Fallahi P. Systemic Lupus Erythematosus and Thyroid Autoimmunity. Front Endocrinol (Lausanne) 2017; 8:138. [PMID: 28674523 PMCID: PMC5474463 DOI: 10.3389/fendo.2017.00138] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/02/2017] [Indexed: 12/26/2022] Open
Abstract
Most of the studies present in the literature show a high prevalence, and incidence, of new cases of hypothyroidism and autoimmune thyroiditis (AT) in systemic lupus erythematosus (SLE) patients, overall in female gender. A limited number of cases of Graves' disease have been also reported in SLE patients, in agreement with the higher prevalence of thyroid autoimmunity. It has been also demonstrated that a Th1 predominance is associated with AT in SLE patients. Furthermore, a higher prevalence of papillary thyroid cancer has been recently reported in SLE, in particular in the presence of thyroid autoimmunity. However, studies in larger number of SLE patients are needed to confirm findings about thyroid cancer. On the whole, data from literature strongly suggest that female SLE patients, with a high risk (a normal but at the higher limit thyroid-stimulating hormone value, positive antithyroid peroxidase antibodies, a hypoechoic pattern, and small thyroid), should undergo periodic thyroid function follow-up, and appropriate treatments when needed. A careful thyroid monitoring would be opportune during the follow-up of these patients.
Collapse
Affiliation(s)
- Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Silvia Martina Ferrari,
| | - Giusy Elia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
12
|
Coexistence of endocrinopathies in children with rheumatic diseases. Int J Pediatr Adolesc Med 2016; 3:119-122. [PMID: 30805481 PMCID: PMC6372428 DOI: 10.1016/j.ijpam.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/24/2022]
Abstract
Background and objectives To examine the frequency of endocrinopathies in children with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA). Design and setting A cross-sectional study. Patients and methods A study was conducted in Saudi children with SLE and JIA who were seen at King Faisal Specialist Hospital and Research Centre, Riyadh, between September 2013 and April 2015. All enrolled patients completed the clinical evaluation, which included information about family history of autoimmune disease, growth parameters and tanner stage, as well as the following assessments: vitamin D profile (parathyroid hormone and 25-OH vitamin D levels), TSH, FT4 and total T3, thyroglobulin antibodies, thyroperoxidase antibodies, random blood sugar, HbA1C, IGF1, IGFBP-3, LH, and FSH. Results A total of 42 patients, 22 with JIA and 20 with SLE, were included in the study. The mean participant age was 12.2 ± 5.3 years with a mean disease duration of 3.2 ± 3.4 years. Female gender was predominant (17 SLE, 13 JIA) in the patient population. Fifteen patients (35.7%) presented with a family history of autoimmune disease. The most frequently detected endocrinopathies were vitamin D insufficiency (35%) and thyroid disease (31%). Eight JIA patients and 7 SLE patients exhibited low vitamin D levels; 10 patients presented with hyperparathyroidism. Thyroid dysfunction was observed in 13 patients (8 SLE, 5 JIA), and 2 patients were found to be euthyroid (normal TSH, FT4) with positive thyroid autoantibodies. Furthermore, 7 patients presented with subclinical hypothyroidism (high TSH, normal FT4), and 4 patients presented with overt hypothyroidism (high TSH, low FT4). Seven patients (4 SLE and 3 JIA) presented with short stature due to growth hormone insufficiency (low IGF1, IGFBP-3). Two patients exhibited delayed puberty accompanied by low LH levels. Diabetes mellitus was more frequently observed in patients with JIA (4 patients) than in patients with SLE (1 patient). Conclusion Our findings demonstrated that coexistence of endocrinopathies is not uncommon in children diagnosed with JIA and SLE. Abnormal thyroid function occurs frequently and at a similar rate in children diagnosed with SLE and JIA. Thus, screening for endocrinopathies, namely thyroid disease, during the assessment of childhood SLE and JIA is worth consideration.
Collapse
|
13
|
Hu Y, Wang H, Deng J. Adult-Onset Still's Disease Associated with Thyroid Dysfunction: Case Report and Review of the Literature. Open Rheumatol J 2014; 8:9-12. [PMID: 25067964 PMCID: PMC4110384 DOI: 10.2174/1874312901408010009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/27/2014] [Accepted: 04/28/2014] [Indexed: 02/05/2023] Open
Abstract
To our knowledge, the possible unveiled interaction between adult-onset Still’s disease (AOSD) with autoimmune thyroid disease (AITD) has never been reported although it is well established that systemic autoimmune disease may usually occur in relation to AITD. As increasingly clear links of AITD with other autoimmune disease such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and primary Sjögren’s syndrome (pSS) have been reported, and the incidence of AOSD concurrent AITD draws our attention rapidly. In this study, we searched relevant literatures published in the past 30 years to explore that condition.
Collapse
Affiliation(s)
- Yingchun Hu
- Department of Geriatrics, West China Hospital, Sichuan University, People's Republic of China
| | - Han Wang
- Department of Cardiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, People's Republic of China
| | - Juelin Deng
- Department of Geriatrics, West China Hospital, Sichuan University, People's Republic of China
| |
Collapse
|
14
|
High prevalence of antinuclear antibodies in children with thyroid autoimmunity. J Immunol Res 2014; 2014:150239. [PMID: 24741574 PMCID: PMC3987791 DOI: 10.1155/2014/150239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antinuclear antibodies (ANA) are a hallmark of many autoimmune diseases and can be detected many years before disease onset. Autoimmune thyroid diseases (AITD) are frequently associated with other organ- and non-organ-specific autoimmune disorders. Objectives. To assess the prevalence of ANA in pediatric patients with AITD and their clinical correlations. METHODS Ninety-three consecutive pediatric patients with AITD were enrolled (86 children with chronic lymphocytic thyroiditis and 7 with Graves' disease). ANA, anti-double DNA (anti-dsDNA) antibodies, anti-extractable nuclear antigen (anti-ENA), anti-cyclic citrullinated peptide antibodies (anti-CCP), and rheumatoid factor (RF) was obtained. Signs and symptoms potentially related to rheumatic diseases in children were investigated by a questionnaire. RESULTS ANA positivity was found in 66/93 children (71%), anti-ENA in 4/93 (4.3%), anti-dsDNA in 1/93 (1.1%), RF in 3/93 (3.2%), and anti-CCP in none. No significant differences were found between the ANA-positive and ANA-negative groups with respect to age, sex, L-thyroxine treatment, or prevalence of other autoimmune diseases. Overall, parental autoimmunity was found in 23%. CONCLUSIONS ANA positivity was demonstrated in 71% of children with AITD. ANA positivity was not related to overt immune-rheumatic diseases. However, because the positivity of ANA can occur even many years before the onset of systemic autoimmune diseases, prospective studies are warranted.
Collapse
|
15
|
Chistiakov DA, Savost’anov KV, Baranov AA. Genetic background of juvenile idiopathic arthritis. Autoimmunity 2014; 47:351-60. [DOI: 10.3109/08916934.2014.889119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
16
|
Nadeau C, Kuperstein AS, Mupparapu M, Stoopler ET. Temporomandibular disorder in a patient with pseudoxanthoma elasticum: a case report and review. SPECIAL CARE IN DENTISTRY 2013; 33:255-9. [DOI: 10.1111/scd.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christine Nadeau
- Resident, Department of Oral Medicine; University of Pennsylvania School of Dental Medicine; Philadelphia; Pennsylvania
| | | | | | | |
Collapse
|
17
|
Kotobuki Y, Tanemura A, Yang L, Itoi S, Wataya-Kaneda M, Murota H, Fujimoto M, Serada S, Naka T, Katayama I. Dysregulation of melanocyte function by Th17-related cytokines: significance of Th17 cell infiltration in autoimmune vitiligo vulgaris. Pigment Cell Melanoma Res 2012; 25:219-30. [PMID: 22136309 DOI: 10.1111/j.1755-148x.2011.00945.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine whether CD4(+) IL-17A(+) Th17 cells infiltrate vitiligo skin and to investigate whether the proinflammatory cytokines related to Th17 cell influence melanocyte enzymatic activity and cell fate. An immunohistochemical analysis showed Th17 cell infiltration in 21 of 23 vitiligo skin samples in addition to CD8(+) cells on the reticular dermis. An in vitro analysis showed that the expression of MITF and downstream genes was downregulated in melanocytes by treatment with interleukin (IL)-17A, IL-1β, IL-6, and tumor necrosis factor (TNF)-α. Treatment with these cytokines also induced morphological shrinking in melanocytes, resulting in decreased melanin production. In terms of local cytokine network in the skin, IL-17A dramatically induced IL-1β, IL-6, and TNF-α production in skin-resident cells such as keratinocytes and fibroblasts. Our results provide evidence of the influence of a complex Th17 cell-related cytokine environment in local depigmentation in addition to CD8(+) cell-mediated melanocyte destruction in autoimmune vitiligo.
Collapse
Affiliation(s)
- Yorihisa Kotobuki
- Department of Dermatology Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Gao H, Li C, Mu R, Guo YQ, Liu T, Chen S, Su Y, Li ZG. Subclinical hypothyroidism and its association with lupus nephritis: a case control study in a large cohort of Chinese systemic lupus erythematosus patients. Lupus 2011; 20:1035-41. [PMID: 21646314 DOI: 10.1177/0961203311401456] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the prevalence of thyroid diseases in Chinese systemic lupus erythematosus (SLE) patients and the relevance of subclinical hypothyroidism (SCH) with lupus nephritis (LN). A large cohort of 1006 SLE patients was retrospectively analyzed. The prevalence of autoimmune thyroid disease was 2.78%, clinical hypothyroidism 1.69%, subclinical hypothyroidism 10.04%, central hypothyroidism 1.29%, hyperthyroidism 1.19%, euthyroid sick syndrome (ESS) 9.54%, and nodules 1.09%, respectively. Compared with the prevalence of thyroid abnormalities in the general Chinese population (0.91–6.05%), SCH was much higher (10.04%) in this study. In addition, SCH was more frequent in patients with LN (13.4%) than those without LN (7.3%, p = 0.001). Case control study was performed to explore the relative risk factors of SCH. In multiple logistic regression models, 24 h urine protein and estimated glomerular filtration rate (eGFR) were retained as independent correlates of SCH after adjusting for demographic variables, risk factors, and other potential confounders. The results of the present study suggest that SCH is a common complication in SLE patients, and closely related with LN.
Collapse
Affiliation(s)
- H Gao
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| | - C Li
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| | - R Mu
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| | - Y-Q Guo
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| | - T Liu
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| | - S Chen
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| | - Y Su
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| | - Z-G Li
- Department of Rheumatology and Immunology, People’s Hospital, Peking University, Beijing, China
| |
Collapse
|
19
|
Parente Costa L, Bonfá E, Martinago CD, de Oliveira RM, Carvalho JF, Pereira RM. Juvenile onset systemic lupus erythematosus thyroid dysfunction: A subgroup with mild disease? J Autoimmun 2009; 33:121-4. [DOI: 10.1016/j.jaut.2009.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 03/31/2009] [Accepted: 04/12/2009] [Indexed: 01/13/2023]
|
20
|
Alvarez Madrid C, González Fernández A, Lisbona Muñoz M, Molina Rodríguez MA, Merino Muñoz R, García-Consuegra Molina J. [Thyroid disorders and childhood rheumatic diseases]. An Pediatr (Barc) 2008; 70:53-6. [PMID: 19174120 DOI: 10.1016/j.anpedi.2008.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 09/16/2008] [Accepted: 09/18/2008] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The relationship between thyroid dysfunction and autoimmune diseases has mainly been described in adults. The aim of this study was to analyse the prevalence and characteristics of thyroid abnormalities in children with rheumatic diseases. PATIENTS AND METHOD One hundred and forty-five patients (109 girls and 36 boys) from a rheumatology paediatric unit were studied for two years. The diagnoses were: juvenile idiopathic arthritis (JIA) (n=115), lupus (n=17), juvenile dermatomyositis (n=5), scleroderma (n=4), and one case each of the following: mixed connective mixed disease, CINCA syndrome (chronic infantile neurological, cutaneous and articular), TRAPS (tumour necrosis factor receptor-associated periodic syndrome), and familial mediterranean fever. T4 and TSH levels were carried out, and if these showed abnormalities, antithyroid antibodies (ATA) were determined. RESULTS Six girls aged between 2 and 17 years old had thyroid abnormalities. Three had JIA and three had lupus. Five were diagnosed with autoimmune hypothyroidism, with high ATA levels, and there was one case of hyperthyroidism. All of the patients with thyroid dysfunction had positive antinuclear antibodies (ANA), compared to 34.5% of the rest of the patients (p=0.003). CONCLUSIONS The prevalence of thyroid abnormalities in children with rheumatic disease was 4.14% to 7.9% in JIA patients with positive ANA, and up to 17.6% with lupus. The majority of patients were asymptomatic. Thyroid hormones should be determined when rheumatic disease is diagnosed and periodically afterwards.
Collapse
Affiliation(s)
- C Alvarez Madrid
- Sección de Reumatología Pediátrica, Hospital Universitario La Paz, Madrid, España
| | | | | | | | | | | |
Collapse
|
21
|
Prahalad S, Glass DN. A comprehensive review of the genetics of juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2008; 6:11. [PMID: 18644131 PMCID: PMC2515830 DOI: 10.1186/1546-0096-6-11] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 07/21/2008] [Indexed: 12/29/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy of childhood which is believed to be influenced by both genetic and environmental factors. The progress in identifying genes underlying JIA susceptibility using candidate gene association studies has been slow. Several associations between JIA and variants in the genes encoding the human leukocyte antigens (HLA) have been confirmed and replicated in independent cohorts. However it is clear that genetic variants outside the HLA also influence susceptibility to JIA. While a large number of non-HLA candidate genes have been tested for associations, only a handful of reported associations such as PTPN22 have been validated. In this review we discuss the principles behind genetic studies of complex traits like JIA, and comprehensively catalogue non-HLA candidate-gene association studies performed in JIA to date and review several validated associations. Most candidate gene studies are underpowered and do not detect associations, and those that do are often not replicated. We also discuss the principles behind genome-wide association studies and discuss possible implications for identifying genes underlying JIA. Finally we discuss several genetic variants underlying multiple clinically distinct autoimmune phenotypes.
Collapse
Affiliation(s)
- Sampath Prahalad
- Assistant Professor of Pediatrics, Division of Immunology and Rheumatology, Department of Pediatrics, University of Utah School of Medicine, P.O Box 581289 Salt Lake City, UT 84158-1289, USA
| | - David N Glass
- Professor of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7030, Cincinnati, OH 45229, USA
| |
Collapse
|
22
|
Nagai Y, Hashimoto C, Abe M, Ishikawa O. Adult-onset Still's disease complicated by multiple cranial nerve palsy and hypothyroidism. J Dermatol 2008; 35:248-9. [PMID: 18419687 DOI: 10.1111/j.1346-8138.2008.00457.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Rezaei N, Gavalas NG, Weetman AP, Kemp EH. Autoimmunity as an aetiological factor in vitiligo. J Eur Acad Dermatol Venereol 2007; 21:865-76. [PMID: 17658994 DOI: 10.1111/j.1468-3083.2007.02228.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Vitiligo is a common dermatological disorder characterized by the presence on the skin of depigmented macules resulting from the destruction of cutaneous melanocytes. Autoimmunity is an important hypothesis with regard to vitiligo aetiology and the evidence for autoimmune responses being involved in the pathogenesis of this disorder will be discussed in the present review. All immune system compartments, including innate and adaptive immunity have been implicated in vitiligo development. Particularly relevant are autoantibodies and autoreactive T cells in vitiligo patients that have cytotoxic effects upon pigment cells. Furthermore, predisposition to vitiligo appears to be associated with certain alleles of the major histocompatibility complex class II antigens as well as with other autoimmune-susceptibility genes. Moreover, the association of vitiligo with autoimmune disorders, the animal models of the disease, and the positive response to immunosuppressive therapeutic agents emphasize the role of autoimmunity in the development of this disorder.
Collapse
Affiliation(s)
- N Rezaei
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
24
|
Selva-O'Callaghan A, Redondo-Benito A, Trallero-Araguás E, Martínez-Gómez X, Palou E, Vilardell-Tarres M. Clinical significance of thyroid disease in patients with inflammatory myopathy. Medicine (Baltimore) 2007; 86:293-298. [PMID: 17873759 DOI: 10.1097/md.0b013e318156f9c2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We conducted the current study to determine the prevalence, incidence density, and clinical significance of thyroid disease in a series of 109 patients diagnosed with idiopathic inflammatory myopathy. We analyzed 109 patients diagnosed with idiopathic inflammatory myopathy during a 20-year period (1986-2006). Routine determination of thyroid profile, including hormone levels and antithyroid antibodies (antithyroid peroxidase and antithyroglobulin antibody systematically, and antithyroid-stimulating hormone receptor antibody when appropriate) was carried out at onset and at least once again during the follow-up period. Human leukocyte antigen (HLA) study was performed by polymerase chain reaction sequence-specific oligonucleotide typing. Six patients (5.5%) developed thyroid disease (hypo- or hyperthyroidism), with an incidence density of 8.7 new cases per 1000 person-years; 4 of the 6 cases were of autoimmune origin (3.6%). Thyroid dysfunction, whether autoimmune or not, was clearly related with onset or relapse of disease activity. Neoplastic disease was detected in 3 of 4 (75%) patients with autoimmune thyroid disease, a significantly higher frequency than was observed in the remaining patients in the series (12 of 103, 11.7%; p < 0.05; RR: 22.8; 95% confidence interval, 2.2-236.6). HLA DRB1*04 was found in 4 of the 6 patients with thyroid disease and inflammatory myopathy. Thyroid disorders are clinically relevant in patients with inflammatory myopathies. An association was observed between autoimmune thyroid disease and cancer. Thyroid assessment is strongly recommended in patients with idiopathic inflammatory myopathy and clinical relapse.
Collapse
Affiliation(s)
- Albert Selva-O'Callaghan
- From Internal Medicine Department (ASO'C, ARB, ETA, MVT) and Preventive Medicine and Epidemiology Department (XMG), Vall d'Hebron General Hospital, Universitat Autonoma Barcelona; and Lirad (EP), Banc Sang I Teixits, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
25
|
Roberti A, Andrade Sobrinho JD, Denardin OVP, Rapoport A. Concomitância da tireoidite de Hashimoto e o carcinoma diferenciado da tireóide. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000600003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a associação da tireoidite auto-imune e o carcinoma diferenciado da tireóide na Santa Casa de Misericórdia de Goiânia-Goiás. MÉTODO: De 1395 tireoidectomias realizadas de 1994 a 2003, foram selecionadas 120 carcinomas diferenciados (27 foliculares e 93 papilíferos). Foram avaliadas as variáveis clínicas (idade e sexo) com apresentação de freqüências e de sumários de medidas-resumo na descrição estatística. Para aferir a associação de tireoidite auto-imune e carcinoma diferenciado da tireóide em função dos achados histopatológicos, utilizou-se tabelas de contingência e análise pelo teste não paramétrico do quiquadrado de Pearson. Em todos os testes estatísticos foi adotado um nível de significância de 5% (p<0,05). RESULTADOS: 11,1% dos carcinomas foliculares e 18,3% dos carcinomas papilíferos estão associados à tireoidite auto-imune. Existe uma relação de freqüências quatro vezes maior da tireoidite auto-imune com o carcinoma diferenciado da tireóide em comparação com outras doenças tireoideanas (16,7% X 3,6%). CONCLUSÕES: Tais resultados permitem inferir que a associação entre a tireoidite auto-imune e o carcinoma diferenciado da tireóide é mais que casual, exigindo uma observação clínico-laboratorial cuidadosa nos portadores da doença auto-imune.
Collapse
|
26
|
Biró E, Szekanecz Z, Czirják L, Dankó K, Kiss E, Szabó NA, Szucs G, Zeher M, Bodolay E, Szegedi G, Bakó G. Association of systemic and thyroid autoimmune diseases. Clin Rheumatol 2005; 25:240-5. [PMID: 16247581 DOI: 10.1007/s10067-005-1165-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Revised: 06/22/2005] [Accepted: 06/22/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There are few large cohort studies available on the association of systemic and thyroid autoimmune diseases. In this study, we wished to determine the association of Hashimoto's thyroiditis (HT) and Graves' disease (GD) with systemic autoimmune diseases. METHODS One thousand five hundred and seventeen patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), mixed connective tissue disease (MCTD), Sjögren's syndrome (SS) and polymyositis/dermatomyositis (PM/DM) were included in the study. The HT and GD were diagnosed based on thorough clinical evaluation, imaging and fine-needle aspiration cytology (FNAC). The frequency of HT and GD in these diseases was assessed. In addition, 426 patients with HT or GD were assessed and the incidence of SLE, RA, SSc, MCTD, SS and PM/DM among these patients was determined. Prevalence ratios indicating the prevalences of GD or HT among our autoimmune patients in comparison to prevalences of GD or HT in the general population were calculated. RESULTS Altogether 8.2% of systemic autoimmune patients had either HT or GD. MCTD and SS most frequently overlapped with autoimmune thyroid diseases (24 and 10%, respectively). HT was more common among MCTD, SS and RA patients (21, 7 and 6%, respectively) than GD (2.5, 3 and 1.6%, respectively). The prevalences of HT in SLE, RA, SSc, MCTD, SS and PM/DM were 90-, 160-, 220-, 556-, 176- and 69-fold higher than in the general population, respectively. The prevalences of GD in the same systemic diseases were 68-, 50-, 102-, 76-, 74- and 37-fold higher than in the general population, respectively. Among all thyroid patients, 30% had associated systemic disease. In particular, 51% of HT and only 16% of GD subjects had any of the systemic disorders. MCTD, SS, SLE, RA, SSc and PM/DM were all more common among HT patients (20, 17, 7, 4, 2 and 2%, respectively) than in GD individuals (2, 5, 5, 1, 2 and 1%, respectively). CONCLUSION Systemic and thyroid autoimmune diseases often overlap with each other. HT and GD may be most common among MCTD, SSc and SS patients. On the other hand, these systemic diseases are often present in HT subjects. Therefore it is clinically important to screen patients with systemic autoimmune diseases for the co-existence of thyroid disorders.
Collapse
Affiliation(s)
- Edit Biró
- 3rd Department of Medicine, University of Debrecen Medical and Health Sciences Center, 22 Moricz street, 4004 Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Aversano M, Caiazzo P, Iorio G, Ponticiello L, Laganá B, Leccese F. Improvement of chronic idiopathic urticaria with L-thyroxine: a new TSH role in immune response? Allergy 2005; 60:489-93. [PMID: 15727581 DOI: 10.1111/j.1398-9995.2005.00723.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between chronic idiopathic urticaria (CIU) and autoimmune thyroiditis (AT) is known, as well as major prevalence of antithyroid antibodies in the allergical subjects and other autoimmune diseases. We have evaluated the effects of l-thyroxine on clinical symptoms of CIU in AT patients suggesting the hypothesis of a new thyroid-stimulating hormone (TSH) role in immune system. METHODS In 20 female patients with CIU + AT, both hypothyroid and euthyroid, we have investigated the therapeutic effects of l-thyroxine dosed to suppress the TSH. Free-T3, Free-T4, TSH, antithyroperoxidase and antithyroglobulin antibodies, total immunoglobulin (Ig)E, Rheuma test and eritro-sedimentation rate were monitored during treatment. RESULTS In 16 patients a strong decrease of urticaria symptoms has happened after 12 weeks. The TPO Ab and HTG Ab clearly decreased in 14 patients. Furthermore, in two patients with rheumatoid arthritis and in two patients with pollen allergy a strong decrease of rheuma test titer and total IgE has happened. CONCLUSION The reason of AT is associated to CIU and others allergical and autoimmune diseases is poorly known. The exclusive hormonal therapy reduces the symptoms of CIU and inflammatory response in many chronic diseases associated to AT. We suggest a stimulatory effect of TSH able to produce considerable changes of the immune response and immune tolerance in patients with AT causing target organs damage. The causal mechanism involves immune, nervous and endocrine system, sharing a common set of hormones, cytokines and receptors, in a unique totally integrated loop (the neuro-immuno-endocrine axis).
Collapse
Affiliation(s)
- M Aversano
- Endocrinology Unit ASL NA3, Naples, Italy
| | | | | | | | | | | |
Collapse
|
28
|
Li J, May W, McMurray RW. Pituitary hormones and systemic lupus erythematosus. ACTA ACUST UNITED AC 2005; 52:3701-12. [PMID: 16320320 DOI: 10.1002/art.21436] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Li
- University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | | |
Collapse
|
29
|
Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine 2004; 71:275-83. [PMID: 15288851 DOI: 10.1016/j.jbspin.2003.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Accepted: 06/05/2003] [Indexed: 11/19/2022]
Abstract
A variety of rheumatic manifestations have been described in association with autoimmune thyroiditis. In the past, most of these manifestations were attributed to the underlying thyroid dysfunction, in particular hypothyroidism. However, a responsibility of the mechanisms involved in the autoimmunity rather than a direct action of thyroid hormones seems supported by the evidences that some rheumatic manifestations may occur even in euthyroid patients, or that they are more frequent in hypothyroid patient with autoimmune thyroiditis than in those without this disease. Rheumatic manifestations could be sometimes attributable to the autoimmune rheumatic diseases frequently associated with autoimmune thyroiditis, such as Sjögren's syndrome, rheumatoid arthritis, systemic lupus erythematosus, or scleroderma. Among the most important or frequent rheumatic manifestations there are a mild non-erosive variety of arthritis, polyarthralgia, myalgia, and sicca syndrome without a true Sjögren's syndrome. Although the possible pathogenesis of these manifestations is not completely established, some hypotheses may be proposed, including a role of autoantibodies characteristics of autoimmune thyroiditis, a possible overlap between autoimmune thyroiditis and some autoimmune rheumatic diseases, and a systemic inflammatory reaction associated with thyroiditis.
Collapse
Affiliation(s)
- Leonardo Punzi
- Division of Rheumatology, Department of Medical and Surgical Sciences, University of Padova, Via Giustiniani 2, Padova 35128, Italy.
| | | |
Collapse
|
30
|
Ongenae K, Van Geel N, Naeyaert JM. Evidence for an autoimmune pathogenesis of vitiligo. PIGMENT CELL RESEARCH 2003; 16:90-100. [PMID: 12622785 DOI: 10.1034/j.1600-0749.2003.00023.x] [Citation(s) in RCA: 267] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Vitiligo is a depigmenting disorder characterized by the development of white patches in various distributions, which are due to the loss of melanocytes from the epidermis. A variety of arguments from clinical observations to research findings in human and animal models support the hypothesis of autoimmunity and are reviewed in this article. The association with autoimmune diseases and organ-specific autoantibodies is well known. Various effective treatment options have an immunosuppressive effect. Today the autoimmune pathogenesis of the disease has become a rapidly evolving field of research. Detection of circulating melanocyte antibodies in human and animal models implicates a possible role of humoral immunity. Histological and immunohistochemical studies in perilesional skin suggest the involvement of cellular immunity in vitiligo. Recently, T-cell analyses in peripheral blood further support this hypothesis. Interestingly, new insights in the association of vitiligo and melanoma may help to clarify the role of autoimmunity in the development of vitiligo.
Collapse
Affiliation(s)
- Katia Ongenae
- Department of Dermatology, Ghent University Hospital, De Pintelaan, Gent, Belgium
| | | | | |
Collapse
|
31
|
Abstract
Orbital inflammatory disease (OID) broadly describes a variety of pathologic processes and clinical presentations. OID may be idiopathic or may be secondary to a systemic inflammatory disease, retained foreign body, or infectious disease. OID includes the spectrum of bacterial or fungal infections, diffuse inflammation of multiple tissues (e.g., sclerosing orbititis or diffuse anterior OID), and preferential involvement of specific orbital structures (e.g., orbital myositis or optic perineuritis). Mimics of OID include congenital orbital mass lesions or orbital neoplastic disease such as lymphoma or rhabdomyosarcoma. The ultimate diagnosis and treatment plan relies on a careful history and detailed clinical examination followed by the judicious use of ancillary diagnostic testing and a comprehensive treatment plan. The purpose of this review is to provide an overview of the spectrum of diseases known as OID, with emphasis on specific diagnostic challenges in the evaluation and management of patients with idiopathic OID.
Collapse
Affiliation(s)
- Lynn K Gordon
- Jules Stein Eye Institute, University of California - Los Angeles and Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.
| |
Collapse
|
32
|
Abstract
Autoimmune thyroid disease (AITD) is common and occurs frequently in conjunction with other diseases. Many putative disease associations have been suggested for AITD but the validity of these associations is not clear in all cases. It is important to define disease associations correctly because this may offer a means to rationally screen for true associations, may shed light on shared pathophysiologic mechanisms and may be important if the associated disease impacts on patient management. This review has examined the evidence base for a large number of the suggested associations.
Collapse
Affiliation(s)
- Richard C Jenkins
- University of Sheffield, Clinical Sciences Centre, Northern General Hospital, Sheffield, United Kingdom
| | | |
Collapse
|
33
|
Pedreira AV, Cathalá SMD, Tavares HC, Fernandes FJF, Silva CIS. Tireoidite bacteriana supurativa: relato de caso e revisão da literatura. Radiol Bras 2002. [DOI: 10.1590/s0100-39842002000600012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neste trabalho é apresentado um caso de tireoidite bacteriana aguda em um criança lúpica de nove anos de idade, em que o diagnóstico precoce foi imprescindível pela gravidade do quadro. Em seguida é apresentada uma revisão da literatura sobre o assunto.
Collapse
|
34
|
Prahalad S, Shear ES, Thompson SD, Giannini EH, Glass DN. Increased prevalence of familial autoimmunity in simplex and multiplex families with juvenile rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 2002; 46:1851-6. [PMID: 12124869 DOI: 10.1002/art.10370] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if the prevalence of autoimmunity among relatives of patients with juvenile rheumatoid arthritis (JRA) is greater than that among relatives of healthy volunteer control subjects. METHODS Interviews were used to obtain histories of the following disorders among living first- and second-degree relatives of 110 patients and 45 controls: alopecia areata, ankylosing spondylitis, dermatomyositis, Graves' disease, Hashimoto thyroiditis, insulin-dependent diabetes mellitus, inflammatory bowel disease, iritis, JRA, multiple sclerosis, psoriasis, RA, systemic lupus erythematosus, and vitiligo. Chi-squares, odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated. Families of 23 JRA affected sibpairs were interviewed subsequently. RESULTS There were no significant differences between patients and controls with regard to age, sex, ethnicity, or family size. Patients had 1,228 relatives and controls had 496 relatives. Of all the relatives of the patients, 155 had at least 1 autoimmune disorder, compared with 20 relatives of the controls (12.6% versus 4.0%; OR 3.4 [95% CI 2.1-5.7], P < 0.000001). The prevalence of autoimmunity was increased in first-degree and in second-degree relatives of patients (16.1% and 10.6%, respectively). The prevalence of Hashimoto thyroiditis was significantly higher in the relatives of patients (OR 3.5 [95% CI 1.6-7.9], P = 0.0008). The prevalences of other disorders were not significantly different. JRA affected sibpair families had an increased prevalence of autoimmunity (15.0%). A history of arthritis was found significantly more frequently in the JRA affected sibpair families, but not in the simplex families. CONCLUSION These data demonstrate that the prevalence of autoimmunity is significantly higher among first- and second-degree relatives of JRA patients. This suggests that clinically different autoimmune phenotypes may share common susceptibility genes, which may act as risk factors for autoimmunity.
Collapse
Affiliation(s)
- Sampath Prahalad
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City 84132, USA.
| | | | | | | | | |
Collapse
|
35
|
Abstract
Type 1A diabetes mellitus has become one of the most intensively studied autoimmune disorders, with characterized animal models and extensive prospective studies of the development of anti-islet autoimmunity. It is now possible to predict the development of type 1A diabetes mellitus, beginning with HLA-encoded genetic susceptibility, followed by the development of a series of anti-islet autoantibodies. Prediction primarily is based on the detection of multiple anti-islet autoantibodies reacting with cloned islet antigens. Multiple international workshops fostered the development of specific and sensitive radioassays for autoantibodies reacting with GAD65 (glutamic acid decarboxylase), ICA512 (also termed IA-2, a tyrosine phosphatase-like protein), and insulin. Similar high throughput radioassays have been applied using autoantigens for additional autoimmune disorders including celiac disease and Addison's disease. Relatives of patients with type 1A diabetes mellitus inherit susceptibility to express multiple autoantibodies, and a subset of autoantibody-positive individuals inherit susceptibility to progress to overt disease. This article reviews autoimmune disorders associated with type 1A diabetes mellitus.
Collapse
Affiliation(s)
- Edwin Liu
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Box B140, 4200 East 9th Ave., Denver, CO 80262, USA
| | | |
Collapse
|
36
|
Abstract
The co-occurrence of autoimmune diseases has been epidemiologically studied and has aided in our understanding of autoimmunity. However, as new perspectives develop on the pathogenesis and natural history of autoimmune diseases, a refinement in the methodology for the study of the co-occurrence of disease is warranted in order to maximize the information that one may realize from such studies. This paper presents some recent results of co-occurrence studies and then proposes several refinements in the design of epidemiological studies in light of current understanding of the natural history of autoimmune diseases. It also suggests an historical perspective on the results of past studies as to the type of information that can be inferred from them.
Collapse
Affiliation(s)
- Scott Sloka
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada.
| |
Collapse
|
37
|
Richette P, Palazzo E, Kahn MF. Coexisting pseudo-xanthoma elasticum and rheumatoid arthritis. three cases and review of the literature. Joint Bone Spine 2001; 68:513-6. [PMID: 11808990 DOI: 10.1016/s1297-319x(01)00317-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pseudo-xanthoma elasticum (PXE) is an inherited disorder of the connective tissue characterized by cutaneous, ocular and vascular lesions. Coexisting PXE and rheumatoid arthritis (RA) is rare because three cases have only been described. We report three new cases of this association. Analysis of these six cases failed to show any particular biological or clinical features of rheumatoid arthritis associated PXE. The possible association of PXE and RA is discussed.
Collapse
Affiliation(s)
- P Richette
- Rheumatology Unit, Hôpital Bichat, Paris, France
| | | | | |
Collapse
|
38
|
Koch CA, Sarlis NJ. The spectrum of thyroid diseases in childhood and its evolution during transition to adulthood: natural history, diagnosis, differential diagnosis and management. J Endocrinol Invest 2001; 24:659-75. [PMID: 11716153 DOI: 10.1007/bf03343911] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this contribution, we review current knowledge on the pathogenesis, diagnosis and differential diagnosis of thyroid disorders in childhood and adolescence, as well as present an update on therapy methods and management guidelines for these disorders. This overview is conceptually divided into two parts, one focusing on thyroid functional disorders, i.e. conditions leading to hyper- and hypothyroidism, and another one pertinent to structural abnormalities of the thyroid gland, i.e. nodular disorders and thyroid cancer. Currently, congenital hypothyroidism is diagnosed in a much more timely fashion rather than in the past, rendering hypothyroidism-related mental retardation and developmental deficits very rare in newborns and children and, hence, diminishing significantly its public health impact. At the same time, considerable advances have occurred in our understanding of the molecular basis of several genetic conditions affecting the thyroid gland in childhood, such as familial non-autoimmune hyperthyroidism, as well as of the pathways leading to thyroid neoplasia.
Collapse
Affiliation(s)
- C A Koch
- Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | | |
Collapse
|