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Karakiliç GD, Borman P, Kocaoğlu S, Büyük F, Bakirci EŞ. Hypothyroidism and autoimmune thyroid disorders in rheumatoıd arthritis: relationship wıth disease activity. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:160-167. [PMID: 38281120 DOI: 10.2478/rjim-2024-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Indexed: 01/29/2024]
Abstract
Background and aims: Thyroid function abnormalities and thyroid autoantibodies have previously been described in rheumatoid arthirits (RA) with limited data. In some studies, a relationship was found between thyroid autoantibodies and RA disease activity. However, there are not strong studies in the literature indicating the relationship between thyroid diseases and RA. The aim of this study was to determine the frequency of hypothyroidism and to investigate the relationship between thyroid hormone levels, autoantibodies and disease activity in patients with rheumatoid arthritis (RA). Methods : 1017 patients with the diagnosis of RA were recruited. This observational study was conducted between January 2014 and July 2015. Demographic variables were recorded. Anti-nuclear antibodies (ANA), anti-cyclic citrulli-nated peptide antibody (anti-CCP), Rheumatoid Factor (RF), C reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-microsomal antibody (anti-TPO )and anti-thyroglobulin antibody (anti-TG) were determined. Visual analog score and Disease Activiy Score 28 (DAS-28) ESR and DAS-28 CRP were recorded. The relationship between thyroid hormone levels and thyroid antibodies and disease activity parameters were determined. Results: 98 (%9,7) patients had hypothyroidism and 61 (%6) patients had hyperthyroidism. 210 (20,7%) patients with RA was positive for TPOAb and 165(16,3%) for anti-TG. Positive correlation was detected between anti-TPO positivity and anti-CCP levels (p:0.005, r:0,274). In anti-TG antibody positive patients, there was a significant positive correlation of thyroid hormone levels with CRP and DAS 28-CRP (p:0.01, r:0,120; p:0.01, r:0,169). Conclusion: Thyroid autoantibodies were found to be positive in 16-21% of patients with RA. Though hypothyroidism is not very frequent in RA patients, autoimmune thyroid disease is quite common, which may be related to disease activity.
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Affiliation(s)
| | - Pinar Borman
- 2Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey
| | - Seher Kocaoğlu
- 3Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ferda Büyük
- 1Department of Physical Medicine and Rehabilitation, Yozgat City Hospital, Yozgat, Turkey
| | - Esra Şahingöz Bakirci
- 1Department of Physical Medicine and Rehabilitation, Yozgat City Hospital, Yozgat, Turkey
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Lichtiger A, Fadaei G, Tagoe CE. Autoimmune thyroid disease and rheumatoid arthritis: where the twain meet. Clin Rheumatol 2024; 43:895-905. [PMID: 38340224 PMCID: PMC10876734 DOI: 10.1007/s10067-024-06888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
Autoimmune thyroid disease (AITD) is the most prevalent autoimmune disease. It shares multiple genetic, clinical, and serologic characteristics with rheumatoid arthritis (RA). Although frequently described as a classic form of single-organ autoimmunity, the AITD disease burden in a subset of patients extends well beyond the thyroid gland. This review explores the complex interaction between the two diseases and the clinical consequences when they overlap. Beyond the well-known effects of AITD on thyroid function in RA, there is mounting evidence of the association of both conditions impacting the presentation and outcomes of diabetes, metabolic syndrome, and cardiovascular disease. An increasing number of studies suggest that there are negative effects of AITD on RA disease activity both in the presence and in the absence of thyroid dysfunction. Recent evidence suggests that AITD may not only worsen the cumulative damage of RA through higher disease activity but may also worsen secondary osteoarthritis changes. Less well-known is the significant association between AITD and chronic widespread pain syndromes including fibromyalgia. Importantly, the presence of fibromyalgia, which is increased in RA patients, appears to be further increased when it overlaps with AITD. Lastly, we probe the possible influence of AITD interacting with RA on fertility and clinical depression. Key Points • Autoimmune thyroid disease is the most common autoimmune disease and is frequently associated with rheumatoid arthritis. • Autoimmune thyroid disease can present with osteoarthritis, inflammatory arthritis, and chronic widespread pain syndromes. • The co-occurrence of autoimmune thyroid disease and rheumatoid arthritis may worsen disease activity and exacerbate other disease manifestations including cardiovascular disease, fertility, and depression. • The overlap of rheumatoid arthritis with autoimmune thyroid disease needs further research and should be sought in general clinical practice.
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Affiliation(s)
- Anna Lichtiger
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Clement E Tagoe
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
- Division of Rheumatology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467-2490, USA.
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Athanassiou L, Kostoglou-Athanassiou I, Kaiafa G, Tsakiridis P, Koukosias N, Mitsoulis S, Savopoulos C, Athanassiou P. Thyroid Disease and Systemic Lupus Erythematosus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1911. [PMID: 38003960 PMCID: PMC10673127 DOI: 10.3390/medicina59111911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Thyroid disease has been associated with autoimmune disorders. As systemic lupus erythematosus (SLE) is a systemic autoimmune disease with diverse manifestations spanning across all organ systems, the relationship of SLE with thyroid disorders needs investigation. In particular, the relationship of SLE with autoimmune thyroid disease has attracted the interest of the research community. The aim was to evaluate the relationship of SLE with autoimmune thyroid disease. Materials and Methods: A cohort of 45 consecutive patients with a mean age of 47.97 years (range 21-79 years) and 45 age- and sex-matched controls were prospectively studied over a period of 12 months for the presence of thyroid disease and the prevalence of antithyroid antibodies. Results: Four patients (8.9%) were found to suffer from primary hypothyroidism, five (11.11%) from subclinical hypothyroidism and one (2.22%) from hyperthyroidism, whereas one (2.22%) of the controls had primary hypothyroidism and one (2.22%) had hyperthyroidism. Five patients (11.11%) had a thyroid hormone profile that was compatible with the presence of euthyroid sick syndrome. Thyroid peroxidase (TPOab) and thyroglobulin (Tgab) antibodies were detected in 20/45 and 15/45 of the SLE population and in 7/45 and 5/45 of the controls, respectively (p < 0.05, chi-square test). Conclusions: In conclusion, the incidence of clinical thyroid disease is greater amongst SLE patients than in a control population, and in a significant number of these patients, antithyroid antibodies are detectable. Thus, a subset of lupus patients appears to be predisposed to the development of thyroid disease, and this should be considered when evaluating patients with SLE.
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Affiliation(s)
- Lambros Athanassiou
- Department of Rheumatology, Asclepeion Hospital, Voula, 16673 Athens, Greece;
| | | | - Georgia Kaiafa
- First Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (G.K.); (C.S.)
| | - Pavlos Tsakiridis
- Department of Rheumatology, St. Paul’s Hospital, 55134 Thessaloniki, Greece; (P.T.); (N.K.); (S.M.)
| | - Nikolaos Koukosias
- Department of Rheumatology, St. Paul’s Hospital, 55134 Thessaloniki, Greece; (P.T.); (N.K.); (S.M.)
| | - Spyridon Mitsoulis
- Department of Rheumatology, St. Paul’s Hospital, 55134 Thessaloniki, Greece; (P.T.); (N.K.); (S.M.)
| | - Christos Savopoulos
- First Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (G.K.); (C.S.)
| | - Panagiotis Athanassiou
- Department of Rheumatology, St. Paul’s Hospital, 55134 Thessaloniki, Greece; (P.T.); (N.K.); (S.M.)
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Chu YC, Yu KH, Lin WT, Wang WT, Chen DP. Finding the Common Single-Nucleotide Polymorphisms in Three Autoimmune Diseases and Exploring Their Bio-Function by Using a Reporter Assay. Biomedicines 2023; 11:2426. [PMID: 37760867 PMCID: PMC10526089 DOI: 10.3390/biomedicines11092426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
In clinical practice, it is found that autoimmune thyroid disease often additionally occurs with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). In addition, several studies showed that eye-specific autoimmune diseases may have a strong relationship with systemic autoimmune diseases. We focused on Graves' disease (GD) with ocular conditions, also known as Graves' ophthalmopathy (GO), trying to find out the potential genetic background related to GO, RA, and SLE. There were 40 GO cases and 40 healthy controls enrolled in this study. The association between single-nucleotide polymorphisms (SNPs) of the co-stimulatory molecule genes and GO was analyzed using a chi-square test. It showed that rs11571315, rs733618, rs4553808, rs11571316, rs16840252, and rs11571319 of CTLA4, rs3181098 of CD28, rs36084323 and rs10204525 of PDCD1, and rs11889352 and rs4675379 of ICOS were significantly associated with GO based on genotype analysis and/or allele analysis (p < 0.05). After summarizing the GO data and the previously published SLE and RA data, it was found that rs11571315, rs733618, rs4553808, rs16840252, rs11571319, and rs36084323 were shared in these three diseases. Furthermore, the bio-function was confirmed by dual-luciferase reporter assay. It was shown that rs733618 T > C and rs4553808 A > G significantly decreased the transcriptional activity (both p < 0.001). This study is the first to confirm that these three diseases share genetically predisposing factors, and our results support the proposal that rs733618 T > C and rs4553808 A > G have bio-functional effects on the transcriptional activity of the CTLA4 gene.
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Affiliation(s)
- Yen-Chang Chu
- Department of Ophthalmology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Kuang-Hui Yu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Wei-Tzu Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (W.-T.L.); (W.-T.W.)
| | - Wei-Ting Wang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (W.-T.L.); (W.-T.W.)
| | - Ding-Ping Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (W.-T.L.); (W.-T.W.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Bagherzadeh-Fard M, Yazdanifar MA, Aghaali M, Masoumi M. The prevalence of thyroid dysfunction and autoimmune thyroid disease in patients with rheumatoid arthritis. BMC Rheumatol 2022; 6:63. [PMID: 36274180 PMCID: PMC9590164 DOI: 10.1186/s41927-022-00293-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is one of the most common chronic non-organ-specific autoimmune diseases; meanwhile, autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disease that can lead to hypo or hyperthyroidism. Although the etiology of both diseases is complex with a combination of genetic and environmental factors, there are overlaps in genes contributing to the pathogenesis of both diseases. Numerous studies found a correlation between thyroid abnormality and RA in different populations, yet some didn’t. This study is aimed to evaluate the prevalence of thyroid dysfunction, AITD, and anti-thyroid peroxidase (anti-TPO) positively in Iranian patients with RA. Methods A total of 250 RA patients and 248 patients with non-inflammatory rheumatologic disease were included in this case–control study. All participants underwent complete clinical and laboratory assessments. Participants were also assessed for thyroid function testing, including anti-TPO antibodies. Results Thyroid dysfunction was twice as common in RA patients as in controls (OR = 2.16; P-value > 0.001). Overt hypothyroidism was the most common thyroid dysfunction among RA patients (58 out of 84). Anti-TPO positivity was also significantly more common in RA compared with controls (OR = 2.65; P-value > 0.001). The proportion of controls and RA patients with AITD were 9 and 21.5%, respectively. AITD was found 2.8 times more common in RA group than controls (OR = 2.77; P-value > 0.001). Conclusion It was demonstrated that RA was an independent factor associated with thyroid dysfunction and AITD. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00293-9.
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Huang CM, Sung FC, Chen HJ, Lin CC, Lin CL, Huang PH. Hypothyroidism risk associated with rheumatoid arthritis: A population-based retrospective cohort study. Medicine (Baltimore) 2022; 101:e28487. [PMID: 35029902 PMCID: PMC8735800 DOI: 10.1097/md.0000000000028487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Studies on the thyroid disease risk in patients with rheumatoid arthritis (RA) associated with comorbidities are limited. This population-based retrospective cohort study investigated the hypothyroidism risk in patients with RA and the role of comorbidities.We used Taiwan National Health Insurance Research Database to identify 16,714 RA patients newly diagnosed in 2000 to 2008 and 66,856 control persons without RA, frequency matched by sex, age, and index year. Incidence and the RA group to controls hazard ratio of hypothyroidism were estimated.The hypothyroidism incidence was 1.74-fold higher in the RA group than in controls (16.6 vs 9.52 per 10,000 person-years), with the Cox method estimated adjusted hazard ratio of 1.67 (95% confidence interval = 1.39-2.00) after controlling for covariates. Near 75% of the study population were women, with the incidence 3.6-time higher than men in both groups. The hypothyroidism incidence increased with age, from 12.1 per 1000 person-years in 20 to 39 years to 20.0 per 1000 person-years in 60+ years in RA patients, higher than that in controls (7.17 vs 10.0 per 1000 person-years, respectively by age). Each comorbidity was related to an increased incidence and higher in the RA group than in controls. Among all comorbidities, stroke exerted the greatest impact in the RA group with an adjusted hazard ratio of 3.85 (95% confidence interval = 1.24-12.0).RA patients have an increased risk of developing hypothyroidism; this risk was pronounced in women and the elderly. RA patients should be closely monitored to prevent the development of hypothyroidism.
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Affiliation(s)
- Chung-Ming Huang
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University College of Chinese Medicine, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- China Medical University College of Medicine, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Po-Hao Huang
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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7
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Zhang X, Xu B, Liu Z, Gao Y, Wang Q, Liu R. Systemic lupus erythematosus with hypothyroidism as the initial clinical manifestation: A case report. Exp Ther Med 2020; 20:996-1002. [PMID: 32742342 PMCID: PMC7388410 DOI: 10.3892/etm.2020.8788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/04/2020] [Indexed: 11/06/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease and hypothyroidism is an organ-specific autoimmune disease. The two diseases may occur successively or simultaneously. The majority of previous studies observed that thyroid disease was more frequent in patients with SLE than in the general population, particularly those who had a higher incidence of anti-thyroid antibodies. However, there are no reported cases of SLE with hypothyroidism as the initial clinical manifestation, to the best of our knowledge. The present study reported on a case of SLE with this unusual initial clinical manifestation and reviewed the literature to estimate the prevalence of clinical hypothyroidism in patients with SLE (range, 3.0-21.4%). The case of the present study had no obvious facial erythema, photosensitivity or recurrent oral ulcers, and only had hypothyroidism as the initial clinical symptom, but the laboratory examination supported the diagnosis of SLE. The present study suggested that in the clinical diagnosis, attention should be paid to screening for connective tissue diseases when diagnosing hypothyroidism, and the importance of thyroid dysfunction should also be recognized in the treatment of SLE.
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Affiliation(s)
- Xuejiao Zhang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ziwei Liu
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Yuanyuan Gao
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Qing Wang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Rui Liu
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Bahn R, Doniach T, McLachlan S. Deborah Doniach: Discovering Thyroid Autoimmunity: The End of Horror Autotoxicus. Thyroid 2020; 30:942-947. [PMID: 32303157 DOI: 10.1089/thy.2020.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Deborah Doniach MD, FRCP was born in Geneva, Switzerland in 1912. She attended high school at the Lycée Molière and medical school at the Sorbonne in Paris. Deborah married Israel (Sonny) Doniach in 1933. After the births of their two children, she resumed her studies at the Royal Free Hospital Medical School in London, graduating in 1945. After additional training in Immunopathology and Endocrinology, Dr. Doniach joined the faculty in the Department of Immunology at the Middlesex Hospital and rose to become Honorary Consultant Immunopathologist and full Professor of Clinical Immunology. During her career, Deborah enjoyed a long and fruitful collaboration with the chemist and immunologist Ivan Roitt. From their partnership sprang the seminal discovery that Hashimoto's thyroiditis is an autoimmune disease in which circulating antibodies target thyroglobulin, a normal thyroid protein. In addition, they demonstrated a separate antibody cytotoxic to thyrocytes, later found to target thyroid peroxidase. These novel insights ran counter to the prevailing scientific dogma contending that antibodies target only nonself antigens. Thus, the field of research into thyroid autoimmunity, and indeed into autoimmune diseases in general, was born. This work spawned a cadre of future investigators whose studies define our current understanding of thyroid autoimmunity and the broader spectrum of autoimmune disease. In her private life, Deborah was a free thinker who defied conventional norms of the day. She was vivacious, warm, and genuinely interested in everybody and everything. Deborah Doniach died on New Year's Day, 2004 at the age of 91.
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Affiliation(s)
- Rebecca Bahn
- Department of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Tabitha Doniach
- Family Practice, Sutter Medical Group of the Redwoods, Santa Rosa, California, USA
| | - Sandra McLachlan
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Waldenlind K, Saevarsdottir S, Bengtsson C, Askling J. Risk of Thyroxine-Treated Autoimmune Thyroid Disease Associated With Disease Onset in Patients With Rheumatoid Arthritis. JAMA Netw Open 2018; 1:e183567. [PMID: 30646250 PMCID: PMC6324433 DOI: 10.1001/jamanetworkopen.2018.3567] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Autoimmune thyroid disease ([AITD] including hypothyroidism and hyperthyroidism) is the most common organ-specific autoimmune disorder and is more prevalent among patients with rheumatoid arthritis (RA). Real-world studies on when and how this increased risk of AITD develops, in association with the time before or after the onset of RA, are lacking. OBJECTIVE To estimate the risk of thyroxine-treated AITD among patients with RA at different time points before and after the diagnosis of RA. DESIGN, SETTING, AND PARTICIPANTS A nationwide register-based case-control and cohort study was conducted between January 1, 2006, and June 30, 2013, with a maximum follow-up time of 7 years before and 8 years after diagnosis of RA. The study used the Swedish Rheumatology Quality Register and linkage to other nationwide registers to identify 8090 adults with new-onset RA and a random population-based sample of 80 782 referents matched by age, sex, and residential area. Statistical analysis was performed from July 1, 2015, to June 30, 2017. EXPOSURES Presence of AITD in the participants in the case-control design and RA in the participants in the cohort design. MAIN OUTCOMES AND MEASURES Prevalence and relative risk of incident AITD before (odds ratios) and after (hazard ratios) diagnosis of RA compared with the population as reference. RESULTS There were 8090 patients with RA (5529 women and 2561 men; mean [SD] age, 58.3 [15.2] years) and 80 782 population-based participants as reference who were identified. By the time of diagnosis of RA, the prevalence of AITD was 10.3% among the patients with RA (n = 832) vs 7.1% among the controls (5725 of 80 350) (odds ratio, 1.5; 95% CI, 1.4-1.7). This increased risk of AITD developed during the 5 years (range, 2-5 years) before diagnosis of RA (odds ratio, 1.5; 95% CI, 1.2-1.8) and peaked by the time of diagnosis of RA (range, 0-3 months before diagnosis of RA) (odds ratio, 5.3; 95% CI, 3.7-7.6). From diagnosis of RA and onward, the risk of developing AITD decreased (range, 2-5 years after diagnosis of RA) (hazard ratio, 0.7; 95% CI, 0.5-1.0). CONCLUSIONS AND RELEVANCE Compared with the general population, Swedish patients with RA appear to have a higher prevalence of thyroxine-treated AITD at diagnosis of RA and an increased incidence of AITD during the 5-year period before diagnosis of RA. After diagnosis of RA, the risk of developing AITD is suggested to decrease below the expected rate. Besides temporal changes in diagnostic intensity, this pattern of risk raises the question whether AITD may influence the pathogenesis of RA (or vice versa) and, conversely, the question whether antirheumatic therapies may prevent AITD.
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Affiliation(s)
- Kristin Waldenlind
- Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Bengtsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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10
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Hamilton DV. Systemic Lupus Erythematosus in a Patient with Hashimoto's Thyroiditis and Pernicious Anaemia. J R Soc Med 2018; 71:147-9. [PMID: 580296 PMCID: PMC1436354 DOI: 10.1177/014107687807100217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Chen YL, Lin JZ, Mo YQ, Liang JJ, Li QH, Zhou CJ, Wei XN, Ma JD, Yang ZH, Zheng DH, Dai L. Joint damage is amplified in rheumatoid arthritis patients with positive thyroid autoantibodies. PeerJ 2018; 6:e4216. [PMID: 29312834 PMCID: PMC5756613 DOI: 10.7717/peerj.4216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/11/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Autoimmune thyroid disease (AITD), which is characterized by an increased presence of thyroid autoantibodies (TAbs), such as antibodies against thyroid peroxidase (TPOAbs) and antibodies against thyroglobulin (TgAbs), has been reported to be associated with rheumatoid arthritis (RA) because AITD and RA both involve autoimmunity. However, few data are available on the incidence of TAbs in Chinese RA patients, and studies on the association between TAbs and joint damage as well as synovitis in RA patients remain sparse. Here, we aimed to evaluate the incidence of TAbs in a consecutive Chinese RA cohort and to investigate whether the elevated presence of TAbs is associated with joint damage and synovitis in RA patients. METHODS A total of 125 hospitalized RA patients were consecutively recruited. Clinical data and available synovial tissues were collected at baseline, and TAbs and thyroid function were detected by chemiluminescent immunoassay. Patients who tested positive for TPOAbs or TgAbs were classified as the TAbs-positive group, and patients who tested positive for neither TPOAbs nor TgAbs were recruited as the TAbs-negative group. Disease activity was assessed using DAS28-ESR (the disease activity score in 28 joints and including the erythrocyte sedimentation rate). X-ray assessment of the hand/wrist was performed according to the Sharp/van der Heijde-modified Sharp score (mTSS), and patients with an mTSS score >10 were defined as having radiographic joint damage (RJD). Serial tissue sections were stained immunohistochemically for CD3, CD15, CD20, CD34, CD38, and CD68, and synovitis were assessed according to Krenn's synovitis score. RESULTS A total of 44 (35%) patients were positive for either TPOAbs or TgAbs. Importantly, there was a significantly greater percentage of patients with RJD in the TAbs-positive group versus the TAbs-negative group (68% vs. 42%, p = 0.005). Compared with the TAbs-negative group, significantly more CD38-positive plasma cells infiltrated the TAbs-positive synovium, and a higher percentage of patients with high-grade synovitis were observed in the TAbs-positive group (5/8, 63% vs. 5/14, 36%). Moreover, RF positivity and disease activity indicators, including TJC28, DAS28-ESR, and CDAI, were significantly higher in the TAbs-positive group (all p < 0.05). Adjusted logistic regression analysis revealed that positive TAbs (OR 2.999, 95% CI [1.301-6.913]; p = 0.010) and disease duration (OR 1.013, 95% CI [1.006-1.019]; p < 0.001) were independently associated with RJD, and an odds ratio of 2.845 (95% CI [1.062-7.622]) was found for RJD in women with positive TAbs (n = 37) compared with those without TAbs (n = 59) (p = 0.038). CONCLUSION Our data showed that joint destruction was amplified in RA patients with an elevated presence of TAbs, which supports the importance and necessity of TAbs and thyroid function screening and monitoring in RA patient management in clinical practice.
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Affiliation(s)
- Yu-Lan Chen
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian-Zi Lin
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ying-Qian Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jin-Jian Liang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qian-Hua Li
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Cheng-Jing Zhou
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Xiu-Ning Wei
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian-Da Ma
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ze-Hong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dong-Hui Zheng
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lie Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Li Q, Wang B, Mu K, Zhang J, Yang Y, Yao W, Zhu J, Zhang JA. Increased Risk of Thyroid Dysfunction Among Patients With Rheumatoid Arthritis. Front Endocrinol (Lausanne) 2018; 9:799. [PMID: 30687237 PMCID: PMC6336701 DOI: 10.3389/fendo.2018.00799] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Thyroid dysfunction seems to be common among rheumatoid arthritis (RA) patients, but the risk of thyroid dysfunction in RA has not been well-defined. Methods: We performed a case-control study of 65 RA patients and 550 matched non-RA subjects to assess the risk of thyroid dysfunction among Chinese RA patients. A systematic review and meta-analysis was also conducted to comprehensively define the relationship between RA and thyroid dysfunction. Results: The case-control study indicated that the prevalence of thyroid dysfunction was significantly higher in RA patients than controls (OR = 2.89, P < 0.001). Further subgroup analyses revealed positive correlations of RA with hypothyroidism (OR = 2.28, P = 0.006) and hyperthyroidism (OR = 8.95, P < 0.001). Multivariate logistic regression analysis revealed an independent association between RA and thyroid dysfunction (Adjusted OR = 2.89, 95%CI 1.63-5.12, P < 0.001). Meta-analysis of 15 independent studies also showed an obviously increased risk of thyroid dysfunction among RA patients (RR = 2.86, 95%CI 1.78-4.58, P < 0.001). Further subgroup analysis showed RA could obviously increase risk of hyperthyroidism (RR = 2.73, 95%CI 1.29-5.77, P = 0.043) and hypothyroidism (RR = 2.02, 95%CI 1.49-2.74, P < 0.001). Conclusion: Our study provides strong evidence for the increased risk of thyroid dysfunction among RA patients. Screening of thyroid dysfunction may be recommended for RA patients.
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Affiliation(s)
- Qian Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Kaida Mu
- Department of Endocrinology & Rheumatology, Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jing Zhang
- Department of Endocrinology & Rheumatology, Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yanping Yang
- Department of Endocrinology & Rheumatology, Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Wei Yao
- Department of Endocrinology & Rheumatology, Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jie Zhu
- Department of Endocrinology & Rheumatology, Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jin-an Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
- *Correspondence: Jin-an Zhang
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Domingues SL, Gonçalves FT, Jorge MLMP, Limongi JE, Ranza R, Jorge PT. HIGH PREVALENCE OF HYPOTHYROIDISM IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT AN INCREASE IN CIRCULATING ANTI-THYROID ANTIBODIES. Endocr Pract 2017; 23:1304-1310. [PMID: 28816533 DOI: 10.4158/ep161664.or] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Because routine investigations are necessary for the early detection of thyroid disease, this study aimed to assess the prevalence of autoimmune thyroid disease (ATD) and thyroid dysfunction (TD) in patients with systemic lupus erythematosus (SLE). METHODS Seventy-nine SLE patients (American College of Rheumatology criteria) and 159 control patients with no diagnosis of autoimmune diseases (except for ATD) were consecutively evaluated regarding changes in laboratory assessments of thyroid function and the presence of ATD. RESULTS ATD was detected in 11.4% of the SLE patients and 13.8% of the control patients (P = .747), whereas TD was detected in 25.3 and 9.4% (P = .002), hypothyroidism was detected in 21.5 and 6.9% (P = .002), and hyperthyroidism was detected in 3.8 and 2.5% (P = .426) of the SLE and control patients, respectively. The mean duration of SLE was longer in patients with TD (P = .036). Mild hypothyroidism was more frequent in the SLE patients with anti-Smith antibodies (P = .029). CONCLUSION Because hypothyroidism was more frequent in SLE patients and the frequency of ATD was high in both groups, the authors suggest that TSH and anti-thyroid antibody levels be assessed in SLE patients. ABBREVIATIONS ACA = anti-cardiolipin antibodies; ANF = anti-nuclear factor; anti-CCP = anti-cyclic citrullinated peptide; anti-dsDNA = anti-double-stranded DNA; anti-RNP = anti-ribonucleoprotein; anti-Scl70 = anti-topoisomerase I antibodies; anti-SM = anti-Smith antigen antibodies; anti-SS-A/Ro = anti-Sjögren syndrome-related antigen A (Ro); anti-SS-B/La = anti-Sjögren syndrome-related antigen B (La); anti-Tg = anti-thyroglobulin; anti-TPO = anti-thyroid peroxidase; ATD = autoimmune thyroid disease; ENA = extractable nuclear antigen; fT4 = free thyroxine; OR = odds ratio; RF = rheumatoid factor; SLE = systemic lupus erythematosus; SLEDAI = SLE Disease Activity Index; TD = thyroid dysfunction; TSH = thyroid-stimulating hormone; TT3 = total triiodothyronine.
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Anoop J, Geetha F, Jyothi I, Rekha P, Shobha V. Unravelling thyroid dysfunction in rheumatoid arthritis: History matters. Int J Rheum Dis 2017; 21:688-692. [PMID: 28217973 DOI: 10.1111/1756-185x.13040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Autoimmune thyroid disease (AITD) frequently coexists with other systemic autoimmune conditions such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Due to the overlapping and nonspecific nature of symptoms, it is difficult to clinically uncover thyroidal illnesses in RA patients. This study was conducted to estimate the prevalence of thyroid dysfunction including the presence of anti-thyroid peroxidase (antiTPO) autoantibodies in patients with RA and to analyze symptomatology of thyroid dysfunction in patients diagnosed with RA. METHODOLOGY This cross-sectional, prospective study was conducted on 100 patients with RA, attending the Rheumatology Outpatient Department at St John's Medical College and Hospital, Bangalore, India. RESULTS Twenty-two patients had biochemical evidence of thyroid dysfunction, hypothyroidism being the commonest (15/22 patients). Although fatigue and hair loss were the most common symptoms, only weight gain and cold intolerance were found to be statistically significant (P < 0.05) predictors of hypothyroidism and 32 patients were antiTPO positive. It was observed that equal numbers of patients developed hypothyroidism after diagnosis of RA and vice versa. CONCLUSION History taking at the bedside to elicit symptoms, especially weight gain and cold intolerance, is quintessential to ensure timely diagnosis of hypothyroidism.
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Affiliation(s)
- Joseph Anoop
- Department of Medicine, AJ Institute of Medical Science, Mangalore, Karnataka, India
| | - Francis Geetha
- Department of Medicine, St. John's Medical College, Bangalore, Karnataka, India
| | - Idiculla Jyothi
- Department of Medicine, St. John's Medical College, Bangalore, Karnataka, India
| | - Pradeep Rekha
- Department of Medicine, St. John's Medical College, Bangalore, Karnataka, India
| | - Vineeta Shobha
- Division of Clinical immunology & Rheumatology, St. John's Medical College, Bangalore, Karnataka, India
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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.
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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
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BUCHANAN WW, BECK JS, ANDERSON JR, GOUDIE RB, GRAY KG, MIDDLETON DG. Family Studies in Auto-Immune Thyroiditis and Connective-Tissue Diseases. Scott Med J 2016; 10:70-4. [PMID: 14272126 DOI: 10.1177/003693306501000205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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BARR M, BUCHANAN WW, DONIACH D, ROITT IM. The Antibody Response to Tetanus Toxoid in Patients with Auto-Immune Thyroiditis. Scott Med J 2016; 9:295-8. [PMID: 14182919 DOI: 10.1177/003693306400900704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Joshi P, Agarwal A, Vyas S, Kumar R. Prevalence of hypothyroidism in rheumatoid arthritis and its correlation with disease activity. Trop Doct 2016; 47:6-10. [PMID: 26792597 DOI: 10.1177/0049475515627235] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To analyse the prevalence of hypothyroidism in rheumatoid arthritis (RA) patients and to elucidate its correlation with disease activity. METHODS A total of 52 RA patients were enrolled in this study. All patients were assessed fully clinically and underwent routine laboratory investigation including thyroid function testing. RESULTS Hypothyroidism (defined as having a TSH level >4.20 μIU/mL) was observed in 20/52 (38.4%). Erythrocyte sedimentation rates (ESR) were found significantly elevated in patients with hypothyroidism compared to those without (36.3 ± 24.2 vs. 24.6 ± 9.0 mm/h). Disease activity parameters such as DAS-28-ESR, tender joint count; VAS scores were also significantly higher in the former. A significant correlation with serum TSH levels was observed with ESR and DAS-28-ESR. CONCLUSION Thyroid function test should be included in clinical evaluation of RA patients.
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Affiliation(s)
- Prakash Joshi
- Assistant Professor, Department of Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Abhishek Agarwal
- Junior Resident, Department of Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Sony Vyas
- Junior Resident, Department of Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Ravindra Kumar
- Scientist Central Research Laboratory, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
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Amin A, Alkemary A, Abdo M, Salama M. Technetium-99m thyroid scan; does it have a diagnostic aid in sub-clinical auto-immune thyroid disease in systemic lupus erythematosus patients? Lupus 2015; 25:155-61. [PMID: 26345676 DOI: 10.1177/0961203315603137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/29/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Technetium-99m (Tc-99m) thyroid scintigraphy is a well known diagnostic tool that shows the entire gland in a single image. We aimed to evaluate its additive diagnostic value in subclinical autoimmune thyroid disease (S-AITD) in systemic lupus erythematosus (SLE) patients. METHODS We investigated 100 systemic lupus erythematosus (SLE) patients without overt thyroid involvement (eight men and 92 women; mean age 40±6.5 years) and 50 age and sex matched controls. All were subjected to thyroid evaluation using anti-thyroglobulin (anti-TG) and anti-thyroid peroxidase (anti-TPO) antibodies; hormones (FT3; FT4 and TSH) and Tc-99m thyroid scintigraphy. RESULTS 14/100 (14%) and none (0%) were positive for S-AITD in SLE and control groups, respectively (P = 0.0001). They were classified by thyroid scintigraphy and hormonal profile into 2/14 Hashimoto; 10/14 atrophic thyroiditis and 2/14 Graves' disease. Anti-TPO was elevated in 12 SLE cases, while anti-TG was elevated in only 2/14 (P = 0.0001). Thyroid scintigraphy showed statistically significant associations with FT4, TSH and anti-TPO. CONCLUSION Tc-99m thyroid scintigraphy may have an additional diagnostic role in S-AITD among SLE patients, with an impact on patient management. This potential needs to be further evaluated in a larger series on a multicenter basis.
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Affiliation(s)
- A Amin
- Nuclear Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - A Alkemary
- Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - M Abdo
- Rheumatology Department, Faculty of Medicine, Cairo University, Egypt
| | - M Salama
- Nuclear Medicine Department, Faculty of Medicine, Cairo University, Egypt
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Bourji K, Gatto M, Cozzi F, Doria A, Punzi L. Rheumatic and autoimmune thyroid disorders: a causal or casual relationship? Autoimmun Rev 2015; 14:57-63. [PMID: 25315745 DOI: 10.1016/j.autrev.2014.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/23/2014] [Indexed: 12/23/2022]
Abstract
A number of dysfunctions may affect the thyroid gland leading either to hyper- or hypothyroidism which are mediated by autoimmune mechanisms. Thyroid abnormalities may represent an isolated alteration or they may be the harbinger of forthcoming disorders as is the case of well-characterized polyendocrine syndromes. Also, they may precede or follow the appearance of rheumatic manifestations in patients affected with connective tissue diseases or rheumatoid arthritis. The mechanisms by which autoimmune thyroid disorders may be linked to systemic autoimmune diseases have not been fully unraveled yet, however alterations of common pathways are suggested by shared genetic variants affecting autoantigen presentation and regulation of the immune response. On the other hand, the higher prevalence of autoimmune thyroid disorders over rheumatic diseases compels the chance of a mere causal concomitancy in the same patient. The aim of our paper is to provide an overview of available data on thyroid involvement in different rheumatic diseases and to go over the main rheumatic manifestations in the context of autoimmune thyroid diseases.
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El-Hadidi KT, Mansour MA, El-Wakd MM, El-Emary AE. Thyroid dysfunction and anti-thyroid antibodies in Egyptian patients with systemic lupus erythematosus: Correlation with clinical musculoskeletal manifestations. THE EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2014.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Raterman HG, Nurmohamed MT. Hypothyroidism in rheumatoid arthritis--to screen or not to screen? J Rheumatol 2013; 39:885-6. [PMID: 22550004 DOI: 10.3899/jrheum.120015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Melcescu E, Kemp E, Majithia V, Vijayakumar V, Uwaifo G, Koch C. Graves' Disease, Hypoparathyroidism, Systemic Lupus Erythematosus, Alopecia, and Angioedema: Autoimmune Polyglandular Syndrome Variant or Coincidence? Int J Immunopathol Pharmacol 2013; 26:217-22. [DOI: 10.1177/039463201302600121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Data on coexisting Graves' disease (GD), hypoparathyroidism, and systemic lupus erythematosus (SLE) are limited. The thyroid and parathyroid glands may be extra sensitive to irradiation damage in an underlying autoimmune condition. A 34-year-old black woman presented with tetanic-like cramps, easy skin bruising, fatigue, weight gain, nocturia and back pain. She was previously diagnosed with GD in 2001 and underwent radioiodine therapy (RAI) in 9/01 using 6 mCi. PostRAI (November 2001) she developed hypocalcemia and hypothyroidism (2/02). In 2007, SLE was diagnosed. In October 2009, s-calcium and PTH were still low at 7.1 mg/dl and 9 pg/mL, respectively, although the patient denied symptoms on vitamin D and calcium supplementation. To identify possible autoimmune damage of the parathyroids, we evaluated the presence of activating antibodies to the CaSR and also analyzed the DNA sequence of all 6 translated exons and flanking intronic sequences of her CaSR gene for a functionally significant CaSR mutation but neither was positive. The initial autoimmune damage to her thyroid and possibly parathyroid glands followed by irradiation of them seems to have contributed to her developing both hypoparathyroidism (11/01) and hypothyroidism (2002). The patient could potentially have had parathyroid autoantibodies in 2001 that disappeared by 2009 when she was tested for them. We consider that the multiple autoimmune conditions developed over the past decade of her life with the concurrent irradiation contributing to her brittle hypoparathyroidism. Select patients with GD and perhaps parathyroid autoantibodies with a slowly developing destructive impact on the parathyroid glands may then develop overt hyoparathyroidism with rather low dose RAI ablation. This patient adds to the evolving spectrum of polyglandular syndrome variants.
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Affiliation(s)
- E. Melcescu
- Department of Medicine/Endocrinology, University of Mississippi Medical Center, Jackson, MS, USA
| | - E.H. Kemp
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - V. Majithia
- Department of Medicine/Rheumatology, University of Mississippi Medical Center, Jackson, MS, USA
| | - V. Vijayakumar
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - G.I. Uwaifo
- Department of Medicine/Endocrinology, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Medicine/Endocrinology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - C.A. Koch
- Department of Medicine/Endocrinology, University of Mississippi Medical Center, Jackson, MS, USA
- Deparmtent of Medicine, University of Dresden, Dresden, Germany
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Cárdenas Roldán J, Amaya-Amaya J, Castellanos-de la Hoz J, Giraldo-Villamil J, Montoya-Ortiz G, Cruz-Tapias P, Rojas-Villarraga A, Mantilla RD, Anaya JM. Autoimmune thyroid disease in rheumatoid arthritis: a global perspective. ARTHRITIS 2012; 2012:864907. [PMID: 23209899 PMCID: PMC3505628 DOI: 10.1155/2012/864907] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/31/2012] [Indexed: 12/14/2022]
Abstract
Objective. To determine the prevalence and impact of autoimmune thyroid disease (AITD) in patients with rheumatoid arthritis (RA). Methods. Eight-hundred patients were included. The association between AITD and RA was analyzed was analyzed by bivariate and multivariate analysis. In addition, a literature review was done focusing on geographical variations. Results. In our cohort the prevalence of AITD was 9.8% while the presence of antibodies was 37.8% for antithyroperoxidase enzyme (TPOAb) and 20.8% for antithyroglobulin protein (TgAb). The presence of type 2 diabetes, thrombosis, abnormal body mass index, and a high educational level was positively associated with AITD. The literature review disclosed a geographical variation of AITD in RA ranging from 0.5% to 27%. Autoantibody prevalence ranges from 6% to 31% for TgAb, 5% to 37% for TPOAb, and from 11.4% to 32% for the presence of either of the two. Conclusion. AITD is not uncommon in RA and should be systematically assessed since it is a risk factor for developing diabetes and cardiovascular disease. These results may help to further study the common mechanisms of autoimmune diseases, to improve patients' outcome, and to define public health policies. An international consensus to accurately diagnose AITD is warranted.
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Affiliation(s)
- Jorge Cárdenas Roldán
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Juan Castellanos-de la Hoz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Juliana Giraldo-Villamil
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Gladys Montoya-Ortiz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Paola Cruz-Tapias
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
- Doctoral Program in Biomedical Sciences, Universidad del Rosario, Bogota, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Rubén D. Mantilla
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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Markson JL, Moore JM. Thyroid Auto-antibodies in Pernicious Anaemia. BRITISH MEDICAL JOURNAL 2011; 2:1352-5. [PMID: 20789550 DOI: 10.1136/bmj.2.5316.1352] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The spectrum of thyroid disorders in systemic lupus erythematosus. Rheumatol Int 2010; 32:73-8. [PMID: 20658291 DOI: 10.1007/s00296-010-1556-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/11/2010] [Indexed: 10/19/2022]
Abstract
To study the spectrum of thyroid disorders in systemic lupus erythematosus (SLE). Hundred SLE patients as per American Rheumatology Association(ARA) classification criteria underwent clinical examination, including assessment of disease activity (SLEDAI) and laboratory evaluation for serum triiodothyronine (T3),free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroperoxidase (TPO) antibody and antithyroglobulin (TG) antibody. Hundred age- and sex-matched apparently healthy individuals served as control. Thirty-six (36%) lupus patients had thyroid dysfunction when compared to 8 (8%) of controls and all of them were women. Primary hypothyroidism was the commonest dysfunction in 14 (14%), while subclinical hypothyroidism and subclinical hyperthyroidism was seen in 12 (12%) and 2 (2%), respectively. Eight (8%) had isolated low T3 consistent with sick euthyroid syndrome. Eighteen (50%) of thyroid dysfunction were autoimmune in nature (autoantibody positive) and rest 18 (50%) were non-autoimmune. Euthyroid state with the elevation of antibodies alone was seen in 12 (12%) of the lupus patients. In contrast, only 5 (5%) of controls had primary hypothyroidism and 3 (3%) had subclinical hypothyroidism, while none had hyperthyroidism. SLEDAI score and disease duration were compared between lupus patients with thyroid dysfunction to those with normal thyroid function. A statistically significant association was found between SLEDAI and thyroid dysfunction of sick euthyroid type.SLE disease duration had no statistically significant association with thyroid dysfunction. Prevalence of thyroid autoantibodies in lupus patients was 30% when compared to 10% of controls. Ninety-six (96%) of the SLE patients were ANA positive, while 4 (4%) of them were ANA negative but were anti-Sm antibody positive. There were no suggestions of any other autoimmune endocrine diseases like diabetes or Addison's disease (clinically and on baseline investigations) in our lupus cohort and hence no further work up was done for these diseases. Thyroid disorders are frequent in SLE and are multifactorial with a definite higher prevalence of hypothyroidism as well as thyroid autoantibodies.
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McIntyre JA, Faulk AWP. Autoantibody potential of cancer therapeutic monoclonal antibodies. Int J Cancer 2010; 127:491-6. [PMID: 19904753 DOI: 10.1002/ijc.25038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We and others have reported that multiple autoantibodies are unmasked in human polyclonal antibody preparations after exposure to physiological oxidizing agents (hemin) or electromotive force. We now have asked if oxidation unmasks autoantibody reactivities in monoclonal antibodies (mAb). To do this, we have studied 9 FDA approved mAb used therapeutically, including 4 chimeric, 4 humanized and 1 chemically modified chimeric Fab that were exposed to the physiological oxidizing agent hemin at 36 degrees C for 20 hr. These mAb were studied for autoantibody activity to phospholipids and DNA before and after oxidation with hemin and found to develop autoantibody activities after oxidation, while retaining their original specificity as measured by mAb anti-glycophorin A binding of erythrocytes, CD 19 binding to B lymphocytes and anti-HLA-A29 binding to A29-positive lymphocytes. The finding that certain mAb have the potential to unmask autoantibody activities as a consequence of exposure to physiological redox reactions in vitro gives pause to our present understanding of the immunological basis of tolerance and concern for potential autoimmune side effects in patients receiving mAb for diagnosis or treatment.
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Affiliation(s)
- John A McIntyre
- St. Francis Hospital and Health Care Centers, Beech Grove, IN, USA.
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Roitt IM, De Carvalho LC. The immunological basis of autoimmune disease. CIBA FOUNDATION SYMPOSIUM 2008:22-34. [PMID: 6216080 DOI: 10.1002/9780470720721.ch3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Organ-specific diseases often involve cell surface antigens which when functionally characterized prove to have some receptor function. Certain restricted parts of the molecule are autoantigenic but the response to these epitopes is similar to that provoked by foreign antigens with respect to diversity of class, clonality and probably idiotypy. The mechanisms controlling the response to components on the surface of the body's cells are not fully understood but might be circumvented by polyclonal activators or by the development of T suppressor dysfunction. The latter could occur through a generalized defect in T suppressor cells, which would account for the association of autoimmune diseases in given individual subjects. Alternatively, or in addition (since genetic studies suggest multifactorial influences), the suppressor defect could be antigen specific. Our studies in chickens with spontaneous autoimmune thyroiditis show that normal antigen is obligatory for both the development and maintenance of autoantibody production and that it is possible that some abnormality or change in the presentation of the autoantigen (rather than its structure) is concerned in the initiation process.
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HOLBOROW EJ, ASHERSON GL, JOHNSON GD, BARNES RD, CARMICHAEL DS. Antinuclear factor and other antibodies in blood and liver diseases. BRITISH MEDICAL JOURNAL 1998; 1:656-8. [PMID: 13961261 PMCID: PMC2123180 DOI: 10.1136/bmj.1.5331.656] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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DONIACH D, RO ITT IM, TAYLOR KB. Autoimmune phenomena in pernicious anaemia. Serological overlap with thyroiditis, thyrotoxicosis, and systemic lupus erythematosus. BRITISH MEDICAL JOURNAL 1998; 1:1374-9. [PMID: 14028630 PMCID: PMC2124044 DOI: 10.1136/bmj.1.5342.1374] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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ANDERSON JR, GRAY KG, BECK JS, BUCHANAN WW, McELHINNEY AJ. Precipitating auto-antibodies in the connective tissue diseases. Ann Rheum Dis 1998; 21:360-9. [PMID: 14012863 PMCID: PMC1007305 DOI: 10.1136/ard.21.4.360] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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TAYLOR KB, ROITT IM, DONIACH D, COUCHMAN KG, SHAPLAND C. Autoimmune phenomena in pernicious anaemia: gastric antibodies. BRITISH MEDICAL JOURNAL 1998; 2:1347-52. [PMID: 13993616 PMCID: PMC1926684 DOI: 10.1136/bmj.2.5316.1347] [Citation(s) in RCA: 307] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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LEE FI, JENKINS GC, HUGHES DT, KAZANTZIS G. PERNICIOUS ANAEMIA, MYXOEDEMA, AND HYPOGAMMAGLOBULINAEMIA--A FAMILY STUDY. BRITISH MEDICAL JOURNAL 1996; 1:598-602. [PMID: 14088313 PMCID: PMC1813888 DOI: 10.1136/bmj.1.5383.598] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
A post-mortem examination, in the case of a 34-year-old man dying suddenly from head injuries sustained in a road accident, showed early cirrhosis of the liver and associated splenomegaly 17 years after an attack of infective hepatitis. The histology of the thymus showed abnormal changes in the medulla, consisting of epithelial hyperplasia and the presence of lymph follicles with germinal centres. It is suggested that an auto-immune mechanism underlay the pathogenesis of the cirrhosis and that the thymic changes were concerned with this.
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WRIGHT R, MORTON JA, TAYLOR KB. IMMUNOLOGICAL STUDIES IN MULTIPLE SCLEROSIS: INCIDENCE OF CIRCULATING ANTIBODIES TO DIETARY PROTEINS AND AUTO-ANTIGENS. BRITISH MEDICAL JOURNAL 1996; 1:491-2. [PMID: 14238678 PMCID: PMC2165888 DOI: 10.1136/bmj.1.5433.491] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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TURNER-WARWICK M, DONIACH D. AUTO-ANTIBODY STUDIES IN INTERSTITIAL PULMONARY FIBROSIS. BRITISH MEDICAL JOURNAL 1996; 1:886-91. [PMID: 14257399 PMCID: PMC2165619 DOI: 10.1136/bmj.1.5439.886] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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WARD JR, CLOUD RS, TURNER LM. NON-CYTOTOXICITY OF "NUCLEAR ANTIBODIES" FROM LUPUS ERYTHEMATOSUS SERA IN TISSUE CULTURE. Ann Rheum Dis 1996; 23:381-8. [PMID: 14206216 PMCID: PMC1010377 DOI: 10.1136/ard.23.5.381] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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BOUCHIER IA, RHODES K, SHERLOCK S. SEROLOGICAL ABNORMALITIES IN PATIENTS WITH LIVER DISEASE. BRITISH MEDICAL JOURNAL 1996; 1:592-4. [PMID: 14088312 PMCID: PMC1813854 DOI: 10.1136/bmj.1.5383.592] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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