Abstract
With the increased pro-inflammatory response in both rheumatoid arthritis and thyroid autoimmune diseases, treatment with biological antirheumatic agents (BAAs) of the former may affect the course of the latter. In hepatitis C and cancer patients, treatment with biological agents substantially increases the risk of developing thyroid autoimmunity. As the use of BAAs in the treatment of rheumatoid arthritis is increasing, this review aimed to investigate if such use affected thyroid status in rheumatoid arthritis patients. We conducted a systematic literature search and included six studies with a total of 311 patients as well as three case reports. The patients were treated with tumor necrosis factor-α inhibitors (infliximab, etanercept, or adalimumab) or the monoclonal CD20-antibody rituximab. There was a non-significant trend of slight improvement of both thyroid function and autoantibody status: a reduction of thyroid peroxidase and thyroglobulin antibody concentrations, and a reduction of thyrotropin levels in hypothyroid patients. Despite the small number of studies, they presented compliant data. The BAAs used in rheumatoid arthritis thus did not seem to negatively affect thyroid status in patients with rheumatoid arthritis and can be considered safe with regard to thyroid autoimmunity. However, the well-established association between rheumatic diseases and thyroid autoimmunity necessitates continued monitoring of thyroid function in patients with rheumatoid arthritis. Each new BAA should be scrutinized for its effect on thyroid as well as other autoimmune diseases in order to establish concise recommendations for patient follow-up for each agent and each disease.
Highlights
Autoimmune thyroid diseases are the most common autoimmune diseases and are often associated with the presence of other organ-specific or non-organ-specific autoimmune diseases (1)
The present review investigates the association between biological antirheumatic treatment of rheumatoid arthritis and affection of thyroid autoimmunity
The present review showed that the biological antirheumatic agents (BAAs) used to treat rheumatoid arthritis did not seem to induce or worsen autoimmune thyroid disease
Summary
Autoimmune thyroid diseases are the most common autoimmune diseases and are often associated with the presence of other organ-specific or non-organ-specific autoimmune diseases (1). The coexistence of thyroid autoimmunity and rheumatoid arthritis has been acknowledged for over a century (2). Population studies have confirmed an increased prevalence of autoimmune thyroid disease in patients with rheumatoid arthritis and an increased prevalence of rheumatoid arthritis in patients with autoimmune thyroid disease (3, 4). Rheumatoid arthritis was the most prevalent coexisting autoimmune disease occurring in Thyroid Autoimmunity in Rheumatoid Arthritis. Fallahi et al (6) found a 2.4% prevalence of rheumatoid arthritis in 3,069 patients with verified autoimmune thyroiditis, which was significantly higher than in patients with multinodular goiter and in thyroid-healthy age- and sex-matched controls (p < 0.0001). In a recent metaanalysis (7), patients with rheumatoid arthritis had a three times higher risk of having thyroid autoantibodies than healthy controls [thyroglobulin autoantibody (TgAb): OR 3.17 (2.24–4.49) and thyroglobulin autoantibody (TPOAb): OR 2.33 (1.24–4.39)]
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