Taşkın ŞENTÜRK, İrfan YAVAŞOĞLU, Adil COŞKUN, Zahit BOLAMAN

ROMATOİD ARTRİTLİ HASTALARDA TİROİD OTOANTİKOR PREVALANSI

Giriş:Romatoid artrit (RA) toplumun yaklaşık %1'ini etkileyen inflamatuar karakterde sistemik otoimmün birhastalıktır ve genellikle sistemik otoimmün hastalıklarla organa özgü otoimmün hastalıkların bir arada görülmesıklığının az olduğu kabul edilir. Biz çalışmamızda RA'li hastalarda, organa özgü otoimmün hastalıkların en sıkgörülenlerinden biri olan otoimmün tiroid hastalığı varlığını ve tiroid otoantikor sıklığını belirlemeyi amaçladık.Materyal ve Metod:Çalışmaya 1987 ARA sınıflama kriterlerine göre RA tanısı konulan ve yaş ortalaması 484olan, 82 aktif hasta (67 kadın ve 15 erkek) kabul edildi. Kontrol grubu olarak 31 kadın ve 16 erkek olmak üzere 47sağlıklı birey çalışmaya dahil edildi. Hasta ve kontrol grubunda serbest tiroksin (sT4), serbest triiodotironin(sT3), tirotropin(TSH), anti-tiroglobulin antikoru (Anti-T) ve anti-peroksidaz antikor (anti-TPO) bakıldı ve ikigrup arasında sonuçlar karşılaştırıldı.Sonuçlar:Serum tiroid otoantikor seviyeleri RA'li hasta grubunda anti-TPO:85.69±106.83 IU/ml ve antiTG:58.2±83.9 IU/ml olarak bulunurken, kontrol grubunda anti-TPO:43.16± 132.23 IU/ml ve antiTG:24.19±36.74 IU/ml olarak bulundu. İki grup arasında tiroid otoantikorlarının serum seviyeleri arasındaistatiksel olarak anlamlı fark saptandı (sırasıyla p=0.008 ve p=0.0004). Tiroid hormon seviyeleri (sT3, sT4 veTSH) açısından 2 grup arasında istatistiksel fark yoktu (p>0.05).Tartışma:Burada elde edilen bulgulara göre RA'li hastalarda otoimmün tiroid hastalığının sıklığı normalpopulasyona göre daha sıktır. Bu da sistemik veya organa özgü olduğuna bakmaksızın, otoimmün hastalıklardaimmün yanıtın tümden etkilendiğini düşündürmektedir. RA'li hastalarda başta otoimmün tiroid hastalığı olmaküzere diğer organa özgü otoimmün hastalıkların gelişimi açısından da dikkatli olunmalıdır

Anahtar Kelimeler:

Romatoid artrit, tiroid otoantikorları

The Prevalance of Thyroid Autoantibodies in Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that affectsapproximately 0.5-1% of the population and according to general opinion the frequency of systemic autoimmune disorders to be seen together with organ specific autoimmune disorders is not very common. The aim of this study was to evaluate the thyroid functions and thyroid autoantibodies in patients with RA and to determine the frequency of autoimmune thyroid disorders in these patients. Materyal and Method: 82 active patients (67 females and 15 males) witha diagnosis of RA according to 1987 ARA classification criteria were included in the study. 47 healthy individuals (31 females and 16 males) were included in the study as the control group. In all participants free thyroxine (fT4), free triiodothyronine (fT3), thyrotropin (TSH), thyroglobulin antibody (anti-Tg) and anti-peroxidase (anti-TPO) antibody titres were measured. Results of the RApatients were compared with the controls. Results: In the RAgroup thyroid autoantibody values were as follows: anti-TPO 85.69±106.83 IU/ml and anti-Tg 58.2±83.9 IU/ml. These values were: anti-TPO 43.16±132.23 IU/ml and anti-Tg 24.19±36.74 IU/ml in the control group. There was a statistically significant difference between two groups with regards to thyroid autoantibodies (p=0.008, p=0.0004, respectively). There was not any statistically significant difference between two groups with regards to fT3, fT4 and TSH values (p > 0.05). Conclusion: As there was not an apperent finding specific for a thyroid disorder in patients with RA in our study, the thyroid antibody positivity identified here might be due to a pathologic autoimmune response rather than demonstrating a thyroid disease.Thyroid function and TPO Ab tests should be performed as part of the biochemical and immunological profile in RApatients.

Keywords:

Rheumatoid arthritis, thyroid autoantibodies,

PDF

___

1. Punzi L, Michelotto M, Pianon M, Bertazzolo N, Fagiolo U, Betterle C, Vettor R, Todesco S. Clinical, laboratory and immunogenetic aspects of arthritis associated with chronic lymphocytic thyroiditis. Clin ExpRheumatol 1997;15:373-80.
2. Pongratz R, Buchinger W, Semlitsch G, Meister E, Nadler K, Rainer F. Increased occurrence of autoimmune thyroiditis in patients with chronic rheumatoid arthritis. Acta Med Austriaca 2000;27:58- 60.
3. Ilias I, Mastorakos G, Mavrikakis M, Papazoglou S, Karamitsos D, Ntantis P, Mantzos E, Mantzos I, Koutras DA. Thyroid disease associated with rheumatoid arthritis is not adequately screened with a sensitive chemiluminescence thyrotrophin assay. Acta MedAustriaca 1999;26:26-8.
4. Innocencio RM, Romaldini JH, Ward LS. Thyroid autoantibodies in autoimmune diseases. Medicina 2004;64:227-30.
5. Caron P, Lassoued S, Dromer C, Oksman F, Fournie A. Prevalence of thyroid abnormalities in patients with rheumatoid arthritis.Thyroidology 1992;4:99-102.
6. Shiroky JB, Cohen M, Ballachey ML, Neville C. Thyroid dysfunction in rheumatoid arthritis: a controlled prospective survey. Ann Rheum Dis 1993;52:454-6.
7. Weetman AP. Non-thyroid autoantibodies in autoimmune thyroid disease. Best Prac Res Clin Endocrinol Metab 2005;19:17-32
8. Ruggeri RM, Galletti M, Mandolfino MG, Aragona P, Bartolone S, Giorgianni G, Alesci D, Trimarchi F, Benvenga S. Thyroid hormone autoantibodies in primary Sjögren syndrome and rheumatoid arthritis are more prevalent than in autoimmune thyroid disease, becoming progressively more frequent in these diseases.JEndocrinolInvest 2002;25: 447-54.
9. Surks MI, Sievert R. Drugs and thyroid functions. N Eng J Med 1995;333:1688-95.
10. Arnaout MA, Nasrallah NS, El-Khateed MS. Prevalence of abnormal thyroid function tests in connective tissue disease. Scand J Rheumatol 1994;23:128-32.
11. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healay LA, Kaplan SR, Liang MH, Luthra HS. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315- 24.
12. McLachlan SM, Rapoport B. Autoimmune response to the thyroid in humans. Thyroid peroxidase: the common autoantigenic denominator. Int Rev Immunol 2000;19:587-618.
13. McIntosh RS, Weetman AP. Molecular analysis of the antibody response to thyroglobulin and thyroid peroxidase. Thyroid 1997;7:471-487.
14. MasukoHongo K, Kato T. The association between autoimmune thyroid diseases and rheumatic diseases: a review. Nippon Rinsho 1999;57:1873-7.
15. Silman AJ, Ollier WE, Bubel MA. Autoimmune thyroid disease and thyroid autoantibodies in rheumatoid arthritis patients and their families. Br J Rheumatol 1989;28:18-21.
16. Andonopoulos AP, SiambiV, Makri M, Christofidoum M, Vagenakis AG. Thyroid function and immune profile in rheumatoid arthritis. A controlled study. Clin Rheumatol 1996;15:599-603.
17. Magnus JH, Birketvedt T, Haga HJ. A prospective evaluation of antithyroid antibody prevalence in 100 patients with rheumatoid arthritis. Scand J Rheumatol 1995;24:180-2.
18. Innocencio RM, Romaldini JH, Ward LS. High prevalence of thyroid autoantibodies in systemic sclerosis and rheumatoid arthritis but not in the antiphospholipid syndrome.Clin Rheum 2003;22:494.
19. Chan AT, Al-Saffar Z, Bucknall RC. Thyroid disease in systemic lupus erythematosus and rheumatoid arthritis. Rheumatology 2001;40:353-4.
20. Del Puente A, Savastano S, Nuzzo V, Esposito A, Lupoli G. High prevalence of thyroid autoantibodies in newly diagnosed rheumatoid arthritis patients. Clin ExpRheumatol 2003;21:137.
21. Marasini B, Massarotti M. Rheumatoid arthritis and thyroid disease.ClinExpRheumatol 2004;22:265.
22. Vaidya B, Pearce SH, Charlton S, Marshall N, Rowan AD, Griffiths ID, Kendall-Taylor P, Cawston TE, Young-Min S. An association between the CTLA4 exon 1 polymorphism and early rheumatoid arthritis with autoimmune endocrinopathies. Rheumatology (Oxford) 2002;41:180-3.
23. Alpigiani MG, Cerboni M, Bertini I, d'Annunzio G, HauptR,IesterA, LoriniR. Endocrine autoimmunity in young patients with juvenile chronic arthritis. Clin Exp Rheumatol 2002;20:565-8.
24. Sening W, Lisner R, Niedobitek G. Rare detection of phenotypically immature lymphocytes in Hashimoto thyroiditis and rheumatoid arthritis. J Autoimmun 2004;22:147-52.
25. Prahalad S, Shear ES, Thompson SD, Giannini EH, Glass DN. Increased prevalence of familial autoimmunity in simplex and multiplex families with juvenile rheumatoid arthritis. Arthritis Rheum 2002;46:1851-6.
26. Tektonidou MG, Anapliotou M, Vlachoyiannopoulos P, Moutsopoulos HM. Presence of systemic autoimmune disorders in patients with autoimmune thyroid diseases.AnnRheum Dis 2004;63:1159-61.