Cross sectional study evaluating the correlation of thyroid dysfunction with severity of disease in rheumatoid arthritis
Keywords:DAS-28 score, Disease activity, Hypothyroidism, Rheumatoid arthritis, Thyroid dysfunction
Background: The present study was conducted to evaluate the correlation of disease severity in RA and thyroid dysfunction.
Methods: The present cross-sectional descriptive study enrolled 164 participants aged 12 years and above diagnosed as having RA. Use of drugs causing thyroid dysfunction, malignancy, diabetes mellitus, systemic hypertension, pregnancy and prior thyroidectomy were the criteria for exclusion. Data was analyzed using R and tests of significance were Chi square test and independent sample t-test and Pearson correlation. Institutional ethics committee approved the study and written informed consent was obtained from all study participants.
Results: Serum TSH positively correlated with DAS 28 (r=0.2, p=0.005), ESR (r=0.2, p=0.03), CRP (r=0.2, p=0.006), RA factor (r=0.2, p=0.003), subjective assessment (r=0.3, p= 0.001) and anti TPO antibodies (r=0.7, p=0.001). Free T4 negatively correlated with DAS28 (r=-0.2, p=0.006), ESR (r=-0.2, p=0.02), CRP (r=-0.2, p=0.01). RA factor (r=-0.2, p=0.01), subjective assessment (r=-0.2, p= 0.01), anti TPO (r=-0.6, p=0.001) and Free T3 negatively correlated with DAS28 score (r=-0.2, p=0.02) , ESR (r=-0.2, p=0.03), RA factor (r=-0.3, p=0.001) and anti TPO antibodies (r=- 0.3, p=0.001).
Conclusions: Hypothyroidism was significantly associated with disease severity of RA with linear positive correlation of TSH with DAS28 score, ESR, CRP, RA factor, subjective assessment and anti TPO antibodies, linear negative correlation of serum free T4 with DAS 28 score, ESR, CRP, RA factor, subjective assessment and anti TPO antibody and linear negative correlation of free T3 with DAS28 score, ESR, RA factor and anti TPO antibody was observed.
Alivernini S, Tolusso B, Petricca L, Ferraccioli G, Gremese E. Chapter 46 - Rheumatoid Arthritis. In: Perricone C, Shoenfeld Y, editors. Mosaic of Autoimmunity. Academic Press; 2019:501-526.
Akhter E, Bilal S, Kiani A, Haque U. Prevalence of arthritis in India and Pakistan: a review. Rheumatol Int. 2011;31(7):849-55.
Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977;7(6):481-93.
Jensen Hansen IM, Asmussen Andreasen R, van Bui Hansen MN, Emamifar A. The reliability of disease activity score in 28 joints-c-reactive protein might be overestimated in a subgroup of rheumatoid arthritis patients, when the score is solely based on subjective parameters. J Clin Rheumatol. 2017;23(2):102-6.
Vollenhoven RF van. Sex differences in rheumatoid arthritis: more than meets the eye. BMC Med. 2009;7:12.
Ngian GS. Rheumatoid arthritis. Aust Fam Physician. 2010;39(9):626-8.
Ghosh SK, Bandyopadhyay D, Biswas SK, Darung I. Mucocutaneous manifestations in patients with rheumatoid arthritis: a cross-sectional study from eastern India. Indian J Dermatol. 2017;62(4):411-7.
Singh B, Mittal B, Bhattacharya A, Deodhar S. A cross sectional evaluation of circulating thyroid hormonal profile in patients with rheumatoid arthritis. Indian J Nucl Med. 2002;17:68-72.
Ghitany MK, Soliman EA, Bondok ME, Elmaadawy SA. Autoimmune thyroid disorders in seropositive versus seronegative rheumatoid arthritis. Egypt J Obes Diabet Endocrinol. 2015;1(1):53.
Gupta G, Sharma P, Kumar P, Itagappa M. Study on subclinical hypothyroidism and its association with various inflammatory markers. J Clin Diagn Res. 2015;9(11):BC04-6.
Joshi P, Agarwal A, Vyas S, Kumar R. Prevalence of hypothyroidism in rheumatoid arthritis and its correlation with disease activity. Trop Doct. 2017;47(1):6-10.
Elattar EA, Younes TB, Mobasher SA. Hypothyroidism in patients with rheumatoid arthritis and its relation to disease activity. Egypt Rheumatol Rehabil. 2014;41(2):58.
Mousa AA, Ghonem M, Hegazy A, El-Baiomy AA, El-Diasty A. Thyroid function and auto-antibodies in Egyptian patients with systemic lupus erythematosus and rheumatoid arthritis. Trends Med Res. 2012;7(1):25-33.
Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine. 2004;71(4):275-83.
El-Sherif WT, El Gendi SS, Ashmawy MM, Ahmed HM, Salama MM. Thyroid disorders and autoantibodies in systemic lupus erythematosus and rheumatoid arthritis patients. Egypt J Immunol. 2004;11(2):81-90.
Chen YL, Lin JZ, Mo YQ, Liang JJ, Li QH, Zhou CJ, et al. Joint damage is amplified in rheumatoid arthritis patients with positive thyroid autoantibodies. Peer J. 2018;6:e4216.
Cárdenas Roldán J, Amaya-Amaya J, Castellanos-de la Hoz J, Giraldo-Villamil J, Montoya-Ortiz G, et al. Autoimmune thyroid disease in rheumatoid arthritis: a global perspective. Arth. 2012;2012:864907.
Ilias I, Mastorakos G, Mavrikakis M, Papazoglou S, Karamitsos D, Ntantis P, et al. Thyroid disease associated with rheumatoid arthritis is not adequately screened with a sensitive chemiluminescence thyrotrophin assay. Acta Med Austriaca. 1999;26(1):26-8.
Innocencio RM, Romaldini JH, Ward LS. Thyroid autoantibodies in autoimmune diseases. Medicina. 2004;64(3):227-30.
Raterman HG, Jamnitski A, Lems WF, Voskuyl AE, Dijkmans BAC, Bos WH, et al. Improvement of thyroid function in hypothyroid patients with rheumatoid arthritis after 6 months of adalimumab treatment: a pilot study. J Rheumatol. 2011;38(2):247-51.