Effect of thyroid dysfunction on disease activity of patients with rheumatoid arthritis

Authors

  • Mir Waseem Department of Medicine, SKIMS SOURA, Srinagar, J&K, India
  • Tabinda Shah Department of Medicine, GMC, Srinagar, J&K, India
  • Mir Nadeem Department of Medicine, GMC, Srinagar, J&K, India
  • Jaspreet Singh Department of Medicine, GMC, Srinagar, J&K, India
  • Saba Maqbool Department of Anaesthesia, SKIMS Medical College Srinagar, J&K, India
  • Chhaya Dahiya Department of Medicine, SGT Medical College, Gurgaon, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20190360

Keywords:

Autoimmunity, Hypothyroidism, Peripheral joints, Rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune systemic inflammatory multisystem disease of unknown cause that may affect many tissues and organs, but principally attacks synovial joints, primarily affecting the peripheral joints in a symmetrical pattern. The pathology of the disease process often leads to destruction of articular cartilage. It is the commonest inflammatory arthropathy worldwide with a gender predilection towards women. Prevalence of RA in the adult general population is approximately 1%. An association between RA and thyroid dysfunction with or without autoimmune origin has been reported in 6% to 34% of patients with RA. On the contrary, when presence of thyroid antibodies is considered, despite normal thyroid function, the prevalence can rise up to about 38%. These rates are significantly greater when compared with the general population.

Methods: RA patients who were diagnosed according to the new 2010 EULAR/ACR criteria and thyroid function tests were done and patients with thyroid dysfunction were identified and then patients were divided into two groups based on presence of thyroid dysfunction with rheumatoid arthritis and disease activity was illustrated in both groups based on different scales.

Results: In all, 250 patients 215 (86.8%) were females and 33 (13.2%) were males. ESR was elevated in 85 (34%) patients while as it was normal in 165(66%) patients. CRP was positive in 127 (52.7%) negative in 123 (47.3%) patients. Although subclinical hypothyroidism was the most frequent abnormality observed in 38.3% patients, only 30% had concomitant anti-TPO raised and 71.4% patients of overt hypothyroidism had raised anti-TPO antibody. Disease activity parameters were significantly higher in patients of RA with hypothyroidism as compared to other group. Although most of parameters of disease activity showed a higher frequency in the group having patients with thyroid disorder but the swollen joint count was comparable in both the groups and was not statistically significant.

Conclusions: Presence of thyroid disorders in RA patients is suggestive of a more aggressive disease. To diagnose concurrent thyroid disorders at an earlier stage, routine measurement of serum thyroid- stimulating hormone is recommended in all RA patients at the time of diagnosis and with yearly interval thereafter.

References

Howard R, Kristine M, Francisco T, Elliot G, Alex JM, Herbert S. Rheumatoid arthritis. e.Medicine, 2006. Available at: https://emedicine.medscape.com/article/331715-overview. Accessed on 24 May 2006.

Raterman H, Jamnitski A, Lems W, Voskuyl A, Dijkmans B, Bos W, et al. Improvement of thyroid function in hypo-thyroid patients with rheumatoid arthritis after 6 months of adalimumab treatment; a pilot study. J Rheumatol. 2011;38:247-51.

Elattar EA, Younes TB and Mobasher SA. Hypothyroidism in patients with rheumatoid arthritis and its relation to disease activity. Egypt Rheumatol Rehabil. 2014;41:58-65.

Cárdenas Roldán J, Amaya-Amaya J, Castellanos-De La Hoz J, Giraldo-Villamil J, Montoya-Ortiz G, Cruz-Tapias P, et al. Autoimmune thyroid disease in rheumatoid arthritis: a global perspective. Arthritis. 2012 Nov 18;2012.

Przygodzka M, Filipowicz-Sosnowska A. Prevalence of thyroid diseases and antithyroid antibodies in women with rheumatoid arthritis. Pol Arch Med Wewn. 2009;119:39-43.

Shiroky JB, Cohen M, Ballachey ML, Neville C. Thyroid dysfunction in rheumatoid arthritis: a controlled prospective survey. Annals of the Rheumatic Diseases. 1993 Jun;52(6):454.

Atzeni F, Doria A, Ghirardello A, et al. Anti-thyroid antibodies and thyroid dysfunction in rheumatoid arthritis: prevalence and clinical value. Autoimmunity. 2008;41:111-5.

Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004 Jan 14;291(2):228-38.

Pan XF, Gu JQ, Shan ZY. Increased risk of thyroid autoimmunity in rheumatoid arthritis: a systematic review and meta-analysis. Endocrine; 2015.

Nadeem M, Khaliq A, Bhat MH, Mustafa F, Mushtaq M, Waseem M. Thyroid dysfunction in rheumatoid arthritis. J Med Sci Clin Res. 2017;5(11):31028-36.

Prevoo ML, Van'T Hof M, Kuper HH, Van Leeuwen MA, Van De Putte LB, Van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38(1):44-4.

Becker KL, Ferguson RH, McConahey WM. The connective-tissue diseases and symptoms associated with Hashimoto’s thyroiditis. N Engl J Med. 1963;268:277-80.

Hart FD. Rheumatoid arthritis: Extra-articular manifestations. II. Br Med .J 1970;2:747-52.

Bashir H, Farooq R, Bhat MH, Majid S. Increased prevalence of subclinical hypothyroidism in females in mountainous valley of Kashmir. Ind J Endocrinol Metab. 2013 Mar;17(2):276.

Jalikhani R, Shivashankara AR, Patil VS. Sameena. Prevalence of thyroid dysfunction in Srinagar, Jammu and Kashmir State of India. International J Med Sci Pub Heal. 2015;4(2).

Tekaya R, Tekaya AB, Sahli H, Mahmoud I, Saidane O, Abdelmoula L. Relationship between autoimmune thyroid disorders and rheumatoid arthritis. JAMPS. 2016;7(1):1-6.

Joshi P, Agarwal A, Vyas S, Kumar R. Prevalence of hypothyroidism in rheumatoid arthritis and its correlation with disease activity. Tropical doctor. 2017 Jan;47(1):6-10.

Downloads

Published

2019-01-25

How to Cite

Waseem, M., Shah, T., Nadeem, M., Singh, J., Maqbool, S., & Dahiya, C. (2019). Effect of thyroid dysfunction on disease activity of patients with rheumatoid arthritis. International Journal of Research in Medical Sciences, 7(2), 491–495. https://doi.org/10.18203/2320-6012.ijrms20190360

Issue

Section

Original Research Articles