Spectrum of Thyroid Disorders in Sero Positive Rheumatoid Arthritis

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by a symmetrical inflammation of the synovium, resulting in tenderness and destruction of bone and cartilage in various joints, particularly the smaller joints of the hands and feet. Although the cause of RA is unknown, autoimmunity plays a pivotal role in its chronicity and progression. Autoimmune thyroid disease (ATD) in the form of Hashimoto's thyroiditis and Graves' disease are all organ-specific. The relationship between RA and the thyroid gland has been studied extensively, with several studies demonstrating the autoimmune nature of thyroid dysfunction in RA.Aims and Objectives: To study prevalence of thyroid dysfunction in rheumatoid arthritis patients.Material and Methods: The present study was conducted in Postgraduate Department of Medicine, Government Medical College Srinagar over a period of 18 months in patients attending OPD clinic. The study was of prospective nature, and analytical cross sectional study.Results: The mean age of patients was 48.2 ± 12.1.ESR was elevated in 89 (23.1%) patients while as it was normal in 296 (76.9%) patients. CRP was positive in 199 (51.7%) patients while as it was negative in 186 (48.3%) patients. RF was more than 3 times elevated in 238 (61.8%) patients, <3 times raised in 131 (34%) patients and negative in only 16 (4.2%) patients. Anti CCP was more than 3 times elevated in 300 (77.9%) patients, <3 times raised in 25 (6.5%) patients and negative in 60 (15.6%) patients.Anti-TPO antibodies were negative in 302 (78.4%) patients with rheumatoid arthritis and was positive in 83 (21.5%) patients.Conclusion: Thyroid dysfunction is prevalent in patients with rheumatoid arthritis with percentage of 41.8%, subclinical hypothyroidism is the most common thyroid dysfunction encountered (37.9%) followed by overt hypothyroidism (3.6%), hyperthyroidism is very rare seen only 0.3% patients. Regular screening of patients is recommended.