Effect of thyroid dysfunction on disease activity of patients with 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.

Correlation of Hypothyroidism With Disease Activity Score-28 in Patients of Rheumatoid Arthritis

“…Similarly, a study by Li et al showed hypothyroidism among 26.2% of patients with RA, which presented a significant association between hypothyroidism and RA[1]. A study byWaseem et al found in their study that 38.2% of patients with RA had hypothyroidism, which was statistically significant[9].In our study, there were 182 (91%) females and 18 (9%) males, which shows an increasing trend of thyroid disease in the female gender. Similarly, in the studies byWaseem et al and Li et al, 86.8% and 80% of females, respectively, were included, which shows an increasing trend of RA and hypothyroidism in the female gender[9,1].…”

“…Similarly, a study by Li et al showed hypothyroidism among 26.2% of patients with RA, which presented a significant association between hypothyroidism and RA [ 1 ]. A study by Waseem et al found in their study that 38.2% of patients with RA had hypothyroidism, which was statistically significant [ 9 ].…”

“…This cross-sectional study was conducted from June 2021 to March 2022 at the department of rheumatology and immunology at Shaikh Zayed Hospital, Lahore, Pakistan, after approval from the Institutional Review Board of Shaikh Zayed Medical Complex Lahore, Pakistan. The sample size of 200 RA patients was estimated using a 95% confidence level and a 5% margin of error with the expected frequency of subclinical and overt hypothyroidism as 41.6% [ 9 ]. Inclusion criteria were any male and female patients aged between 18 and 70 years.…”

“…On the contrary, if thyroid antibodies are present, the prevalence rate can rise up to about 38% [ 8 ]. In a study carried out in India in 2018 among 250 patients with RA, 41.6% of patients had hypothyroidism, subclinical and overt both combined [ 9 ]. Routine screening of thyroid dysfunction in the general population is not suggested; however, evaluation of high-risk groups is advised.…”

“…According to a study, 95% of RA patients having thyroid dysfunction had high disease activity as compared to only 37% of patients without thyroid dysfunction. Due to these findings, the screening of thyroid dysfunction is recommended at the start of the treatment and then on yearly basis [ 9 ].…”