Tsuji Hideaki, Hashimoto Motomu, Harada Takanari, Tanaka Masao, Ito Hiromu, Murakami Kosaku, Ohmura Koichiro, Fujii Takao, Mimori Tsuneyo
Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Mod Rheumatol. 2020 Jul;30(4):640-647. doi: 10.1080/14397595.2019.1649109. Epub 2019 Aug 8.
To determine the clinical characteristics of rheumatoid arthritis (RA) patients with low serum triiodothyronine (T3) levels. We evaluated serum free T3 (fT3), free T4, and thyroid-stimulating hormone (TSH) levels in 338 RA patients. After excluding patients taking anti-thyroid drugs or having anti-thyroid antibodies, we compared the clinical characteristics of the RA patients with low fT3 to those with normal/high fT3, before and after RA treatment. Six percent of RA patients had low fT3 levels. Patients with low fT3 were older and had higher disease activity scores (DAS28), higher Steinbrocker stage, higher health assessment questionnaire scores, lower body mass index, and lower hemoglobin and albumin levels compared with normal/high-fT3 patients. After RA treatment, fT3 levels normalized in half of the low-fT3 patients and remained low in the other half. Although DAS28 scores were similarly improved in both subgroups of the low-fT3 patients, anemia and hypoalbuminemia did not normalize in the persistently low-fT3 subgroup. Low serum fT3 levels represent the profound wasting seen in RA patients that is characterized by anemia and hypoalbuminemia and that cannot be evaluated by DAS28 scores alone.
为确定血清三碘甲状腺原氨酸（T3）水平低的类风湿关节炎（RA）患者的临床特征。我们评估了338例RA患者的血清游离T3（fT3）、游离T4和促甲状腺激素（TSH）水平。在排除服用抗甲状腺药物或存在抗甲状腺抗体的患者后，我们比较了RA治疗前后fT3水平低的RA患者与fT3水平正常/高的患者的临床特征。6%的RA患者fT3水平低。与fT3水平正常/高的患者相比，fT3水平低的患者年龄更大，疾病活动评分（DAS28）更高，Steinbrocker分期更高，健康评估问卷评分更高，体重指数更低，血红蛋白和白蛋白水平更低。RA治疗后，一半fT3水平低的患者fT3水平恢复正常，另一半则仍低。尽管fT3水平低的患者的两个亚组的DAS28评分均有类似改善，但持续性fT3水平低的亚组中的贫血和低白蛋白血症并未恢复正常。血清fT3水平低代表RA患者中出现的以贫血和低白蛋白血症为特征的严重消瘦，且不能仅通过DAS28评分来评估。
