Ümit KARAOĞULLARINDAN, Emine TARHAN, Güzide Gonca ÖRÜK

Psöriatik artrit hastalarında otoimmun tiroid hastaliği sıklığı ve anti TNF-a tedavisinin etkisi

Amaç: Bu çalışmada psöriatik artrit (PsA) hastalarında tiroid hastalığı sıklığı ve anti-TNF tedavinin otoimmun tiroid hastalığına olan etkisi araştırılmıştır..Gereç ve Yöntem: Romatoloji polikliniğinde PsA tanısıyla takip edilen 95 hastanın tiroid stimülan hormonu (TSH), triiyodotironin (sT3), tiroksin (sT4), antitiroglobulin (Tg) ve anti-tiroid peroksidaz (TPO) retrospektif olarak incelendi. Çalışmaya, verileri eksiksiz olan ve tiroid hastalığına yol olan sekonder nedeni olmayan 66 adet PsA (F / M: 43/23) ve 35 sağlıklı kontrol (F / M: 25/10) alındı. Tüm olgulara endokrinoloji uzmanı tarafından tiroid ultrasonografisi yapıldı.Bulgular: PsA hastalarından 38 tanesi hastalık modifiye edici antiromatizmal ajan (DMARD) tedavisi (Grup 1; ortalama yaş: 43.94 ± 9.81) ve 28 hasta anti-TNF-α tedavisi (Grup 2; ortalama yaş: 42.25 ± 11.48) alıyordu. Grup 3 sağlıklı kontrollerden oluşuyordu (yaş ortalaması: 40,52 ± 8,34). Tüm grupların ortalama anti-TPO değerleri ve anti-Tg değerleri arasında anlamlı farklılıklar gözlendi.Sonuç: PsA hastalarında otoimmün tiroid bozuklukları kontrol grubundan daha sık gözlendi. DMARD alan PsA hastalarında anti-TNF-α tedavisi alan hastalardan daha sık otoimmün tiroid bozuklukları görüldü. Bu durum tiroid bozukluklarının patogenezinde TNF-α nın rolü olabileceğini gösterdi.

Anahtar Kelimeler:

psoriatic arthritis, anti-TNF

Frequency of autoimmune thyroid disorders in patients with psoriatic arthritis and effect of anti-TNF alpha treatment

Purpose: In this study, the frequency of thyroid disorders in psöriatic arthritis (PsA) patients and the effect of anti TNF-α treatment on autoimmune thyroid disease were investigated.Materials and Methods: Thyroid stimulating hormone, triiodothyronine, thyroxine, antithyroglobulin(Tg) and anti-thyroid peroxidase (TPO) of 95 patients followed at the rheumatology outpatient clinic were retrospectively evaluated. Sixty-six patients with PsA (F/M: 43/23) whose data were complete, and 35 healthy controls (F/M: 25/10) were included in the study. Thyroid ultrasonography was applied to all cases by an endocrinology specialist.Results :38 of the PsA patients received disease modifying antirheumatic drugs (DMARDs) (Group 1; mean age: 43.94±9.81), and 28 anti TNF-α treatment (Group 2; mean age:42.25±11.48). Group 3 was comprised of healthy controls (mean age: 40.52±8.34). Significant differences were observed between the mean anti-TPO values and anti-Tg values of all groups.Conclusion:: Autoimmune thyroid disorders were observed more frequently in patients with PsA than in the control group. The PsA patients who are receiving DMARDs appeared to have autoimmune thyroid disorders more frequently than those receiving anti TNF-α treatment. This condition may be resulting from TNF-α on the pathogenesis of thyroid disorders.

Keywords:

Psoriatic arthritis anti-TNF, thyroid dysfunction,

PDF

___

1. Gladman DD, Antoni C, Mease P, D O Clegg, P Nash. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64:14-7.
2. Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ, Helliwell P, Boehncke WH et al. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis. 2009;68:1387–94
3. Wright V, Moll JM. Psoriatic arthritis. Bull Rheum Dis. 1971;21:627-32.
4. Queiro-Silva R, Torre-Alonso JC, Tinturé-Eguren T, López-Lagunas I. A polyarticular onset predicts erosive and deforming disease in psoriatic arthritis. Ann Rheum Dis. 2003;62:68-70.
5. Brockbank J, Gladman D. Diagnosis and management of psoriatic arthritis. Drugs. 2002;62:2447-57.
6. Gladman DD. Toward unravelling the mystery of psoriatic arthritis. Arthritis Rheum. 1993;36:881-4.
7. Espinoza LR,Aguilar JL,Espinoza CG, Cuéllar ML, Scopelitis E, Silveira LH. Fibroblast function in psoriatic arthritis.I. Alteration of cell kinetics and grow factor responses. J Rheumatol. 1994;21:1502-6.
8. Fraser A, Fearon U, Reece R, Emery P, Veale DJ. Matrix metalloproteinase 9, apoptosis and vascular morphology in early arthritis. Arthritis Rheum. 2001;44:2024-8.
9. Ritchlin C, Haas-Smith SA, Schwartz E. Osteoclast precursors are markedly increased in the peripheral blood of psoriatic arthritis patients. Arthritis Rheum. 2001;44:325.
10. Espinoza LR, Jara LJ, Espinoza CG, Silveira LH, Martinez-Osuna P, Seleznick M. There is an association between human immunodeficiency virüs infection and spondyloartropathies. Rheum Dis Clin North Am. 1997;18:257-66.
11. Harvey AR, Champe CP. Lippincott's Illustrated Reviews: Biochemistry, 4th Edition. Philadelphia, PA, LWW, 2007.
12. Michalek K, Morshed SA, Latif R, Davies TF. TSH receptor autoantibodies. Autoimmun Rev. 2009;9:113-6.
13. Biró E, Szekanecz Z, Czirják L, Dankó K, Kiss E, Szabó N et al. Association of systemic and thyroid autoimmune diseases. Clin Rheumatol. 2006;25:240– 245.
14. Scofield RH, Bruner GR, Harley JB, Namjou B . Autoimmune thyroid disease is associated with a diagnosis of secondary Sjögren’s syndrome in familial systemic lupus. Ann Rheum Dis. 2007;66:410-3.
15. Boey ML, Fong PH, Long PH, Lee JSC, Ng WY, Thaı AC. Autoimmune thyroid disorders in SLE in Singapore. 1993;2:51–4.
16. 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;11:81–90.
17. Goh KL, Wang F. Thyroid disorders in systemic lupus erythematosus. Ann Rheum Dis. 1986;45:579–83.
18. Wassen FW, Moerings EP, Van Toor H, De Vrey EA, Hennemann G, Everts ME. Effects of interleukin-1 beta on thyrotropin secretion and thyroid hormone uptake in cultured rat anterior pituitary cells. Endocrinology. 1996;137:1591–8.
19. Kennedy JA, Wellby ML, Zotti R. Effect of interleukin-1 beta, tumour necrosis factor-alpha and interleukin-6 on the control of thyrotropin secretion. Life Sci. 1995;57:487–501.
20. Diez JJ, Hernanz A, Medina S, Bayon C, Iglesias P. Serum concentrations of tumour necrosis factor-alpha (TNF-alpha) and soluble TNF-alpha receptor p55 in patients with hypothyroidism and hyperthyroidism before and after normalization of thyroid function. Clin Endocrinol (Oxf). 2002;57:515–21.
21. Tsai TF, Lee CH, Huang YH, Chi CC, Chang YT, Wong TW. Taiwanese Dermatological Association consensus statement on management of psoriasis. Dermatol Sin. 2017;35:66-77.
22. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. 1996;335:99–107.
23. Pérez B, Kraus A, López G, Cifuentes M, AlarcónSegovia D. Autoimmune thyroid disease in primary Sjogren’s syndrome. Am J Med. 1995;99:480–4.
24. Scofield RH. Autoimmune thyroid disease in systemic lupus erythematosus and Sjogren’s syndrome. Clin Exp Rheumatol. 1996;14:321–30.
25. Chan AT, Al-Saffar Z, Bucknall RC. Thyroid disease in systemic lupus erythematosus and rheumatoid arthritis. Rheumatology. 2001;40:353–4.
26. Pyne D, Isenberg DA. Autoimmune thyroid disease in systemic lupus erythematosus. Ann Rheum Dis. 2002;61:70–2.
27. Tsai TF, Wang TS, Hung ST, Tsai PI, Schenkel B, Zhang M et al. Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan. J Dermatol Sci. 2011;63:40-6.
28. Vassilatou E, Papadavid E, Papastamatakis P, Alexakos D, Koumaki D, Katsimbri P et al. No association of psoriasis with autoimmune thyroiditis. J Eur Acad Dermatol Venereol. 2017;31:102-6.
29. Durham LE, Taams LS, Kirkham BW. Psoriatic arthritis. Br J Hosp Med. 2016;77:102–8.
30. Bianchi G, Marchesini G, Zoli M, Falasconi MC, Iervese T, Vecchi F et al. Thyroid involvement in chronic inflammatory rheumatological disorders. Clin Rheumatol.1993;12:479–84.
31. Fallahi P, Ferrari SM, Ruffilli I, Elia G, Miccoli M, Sedie AD et al. Increased incidence of autoimmune thyroid disorders in patients with psoriatic arthritis: a longitudinal follow-up study. Immunol Res. 2017;65:681–6.
32. Antonelli A, Delle Sedie A, Fallahi P, Ferrari SM, Maccheroni M, Ferrannini E et al. High prevalence of thyroid autoimmunity and hypothyroidism in patients with psoriatic arthritis. J Rheumatol. 2006;33:2026-8.
33. Ferrari SM, Ruffilli I, Colaci M, Antonelli A, Ferri C, Fallahi P. CXCL10 in psoriasis. Adv Med Sci. 2015;60:349–54.
34. Antonelli A, Fallahi P, Delle Sedie A, Ferrari SM, Maccheroni M, Bombardieri S et al. High values of Th1 (CXCL10) and Th2 (CCL2) chemokines in patients with psoriatic arthritis. Clin Exp Rheumatol. 2009;27:22–7.
35. Antonelli A, Fallahi P, Delle Sedie A, Ferrari SM, Maccheroni M, Bombardieri S et al. High values of alpha (CXCL10) and beta (CCL2) circulating chemokines in patients with psoriatic arthritis, in presence or absence of autoimmune thyroiditis. Autoimmunity. 2008;41:537–40.
36. Tan JK, Aphale A, Malaviya R, Sun Y, Gottlieb AB. Mechanisms of action of etanercept in psoriasis. J Investig Dermatol Symp Proc. 2007;12:38–45.
37. Allanore Y, Bre´mont C, Kahan A, Menke`s CJ. Transient hyperthyroidism in a patient with rheumatoid arthritis treated by etanercept. Clin Exp Rheumatol. 2001;19:356–7.
38. Van Lieshout AW, Creemers MC, Radstake TR, Elving LD, Van Riel PL. Graves’ disease in a patient with rheumatoid arthritis during treatment with antitumor necrosis factor-alpha. J Rheumatol. 2008;35:938–9.
39. Chen K, Wei Y, Sharp GC, Braley-Mullen H. Decreasing TNF-alpha results in less fibrosis and earlier resolution of granulomatous experimental autoimmune thyroiditis. J Leukoc Biol. 2007;81:306– 14. 40. Tarhan F, Oruk G, Niflioglu O, Ozer S. Thyroid involvement in ankylosing spondylitis and relationship of thyroid dysfunction with anti-TNF treatment. Rheumatol Int. 2013;33:853–7.
41. Raterman HG, Jamnıtskı A, Lems WF, Voskuyl AE, Dıjkmans BA, 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;38:247–51 .
42. Sabugo F, Liberman C, Niedmann JP, Soto L, Cuchacovich M. Infliximab can induce a prolonged clinical remission and a decrease in thyroid hormonal requirements in a patient with SAPHO syndrome and hypothyroidism. Clin Rheumatol. 2008;27:533–5.