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.
ElattarEAYounesTBMobasherSA. Hypothyroidism in patients with rheumatoid arthritis and its relation to disease activity. Egypt Rheumatol Rehabil2014; 41: 58–65.
2.
Cárdenas RoldánJAmaya-AmayaJCastellanos-de la HozJ. Autoimmune thyroid disease in rheumatoid arthritis: a global perspective. Arthritis2012; 2012: 864907–864907.
3.
BenamourSZeroualBFaresLel KabliHBettalS. Rheumatoid arthritis in Morocco. Rev Rhum Mal Osteoartic1992; 59(12): 801–807.
4.
LazúrováIBenhatchiKRovenskýJ. Autoimmune thyroid disease and autoimmune rheumatic disorders: a two- sided analysis. Ann N Y Acad Sci2009; 1173: 211–216.
5.
RatermanHJamnitskiALemsW. Improvement of thyroid function in hypothyroid patients with rheumatoid arthritis after 6 months of adalimumab treatment: a pilot study. J Rheumatol2011; 38: 247–251.
6.
DelamereJScottDFelix DaviesD. Thyroid dysfunction and rheumatic diseases. J R Soc Med1982; 75: 102–106.
7.
ArnaoutMNasrallahNElKhateedM. Prevalence of abnormal thyroid function tests in connective tissue disease. Scand J Rheumatol1994; 23: 128–132.
8.
SurksISievertR. Drugs and thyroid functions. N Eng J Med1995; 333: 1688–1695.
9.
ArnettFCEdworthySMBlochDA. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum1988; 31: 315–324.
10.
AletahaDNeogiTSilmanAJ. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis2010; 69: 1580–1588.
11.
PrevooMLvan’t HofMAKuperHH. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum1995; 38(1): 44–48.
12.
BeckerKLFergusonRHMcConaheyWM. The connective-tissue diseases and symptoms associated with Hashimoto’s thyroiditis. N Engl J Med1963; 268: 277–280.
13.
HijmansWDoniachDRoittIMHolborowEJ. Serological overlap between lupus erythematosus, rheumatoid arthritis, and thyroid auto-immune disease. Br Med J1961; 2: 909–914.
14.
HartFD. Rheumatoid arthritis: Extra-articular manifestations. II. Br Med J1970; 2: 747–752.
15.
UnnikrishnanAGKalraSSahayRKBantwalGJohnMTewariN. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metabol2013; 17(4): 647–652.
16.
ShirokyJBCohenMBallacheyMLNevilleC. Thyroid dysfunction in rheumatoid arthritis: A controlled prospective survey. Ann Rheum Dis1993; 52: 454–456.
17.
RatermanHVnHalmVVoskuylASimsekSDijkmansBANurmohamedMT. Rheumatoid arthritis is associated with a high prevalence of hypothyroidism that amplifies its cardiovascular risk. Ann Rheum Dis2008; 67: 229–232.
18.
MousaAGhonemMHegazyABaiomyAEl-DiastyA. Thyroid function and autoantibodies in Egyptian patients with systemic lupus erythemaosus and rheumatoid arthritis. Trends Med Res2012; 7: 25–33.
19.
McCoySCrowsonCSGabrielSEMattesonEL. Hypothyroidism as a risk factor for development of cardiovascular disease in patients with rheumatoid arthritis. J Rheumatol2012; 39: 954–958.
20.
IliasIMastorakosGMavrikakisM. Thyroid disease associated with rheumatoid arthritis is not adequately screened with a sensitive chemiluminescence thyrotropin assay. Acta Med Austraica1999; 26: 26–28.
21.
StaykovaN. Rheumatoid arthritis and thyroid abnormalities. Folia Med (Plovdiv)2007; 49: 5–12.
22.
TarhanFOrukGNifliogluOOzerS. Thyroid involvement in ankylosing spondylitis and relationship of thyroid dysfunction with anti-TNFα treatment. Rheumatol Int2013; 33: 853–857.
