乳糜泻是自身免疫性甲状腺疾病患者发生血清阴性关节炎的一个风险因素。

Coeliac disease is a risk factor for the development of seronegative arthritis in patients with autoimmune thyroid disease.

机构信息

Department of Clinical Medicine and Surgery, Endocrinology Unit.

Department of Clinical Medicine and Surgery, Rheumatology Unit, Federico II University of Naples, Naples, Italy.

出版信息

Rheumatology (Oxford). 2021 May 14;60(5):2440-2447. doi: 10.1093/rheumatology/keaa640.

DOI:10.1093/rheumatology/keaa640

PMID:33197262

Abstract

OBJECTIVE

Hashimoto's thyroiditis is known to cluster with other systemic autoimmune disorders. Rheumatic manifestations, such as a seronegative non-erosive polyarthritis have been described. The aim of this study was to evaluate the characteristics and the prevalence of rheumatic features in thyroiditis patients, and to ascertain whether the association with systemic autoimmune disorders improved the arthritis manifestations.

METHODS

In total, 180 thyroiditis patients were enrolled. Major clinical and demographic characteristics have been recorded. Patients underwent a rheumatological clinical assessment and extra-articular manifestations allowing for a differential diagnosis with systemic autoimmune diseases and spondyloarthropathy. Presence of systemic autoimmune diseases was recorded.

RESULTS

A total of 8.33% of thyroiditis patients shown a peripheral inflammatory arthritis (P = 0.002). Female gender (P = 0.042) and thyroid peroxidase (TPOAbs) positivity (P = 0.001) were more frequent. In total, 37 patients had systemic autoimmune diseases (P = 0.0003). A significant high prevalence of coeliac disease and Addison disease was found (P = 0.034 and P = 0.049, respectively). In patients with coeliac disease, the articular manifestations were more frequent (21.21%) (P = 0.001) and the risk to develop joint involvement was 2.96.

CONCLUSION

Although we found an articular involvement in about one-third of thyroiditis patients, the prevalence of inflammatory arthropathy was only 8.33%. The prevalence of other coexisting autoimmune disorders was 34.26% with a significant prevalence of coeliac disease (7.41%). Thyroiditis patients with coeliac disease have an articular involvement more frequently than those without. In these patients, we have found a high risk of developing arthritis than patients with only thyroiditis, suggesting cumulative autoimmune effects in the developing articular involvement.

摘要

目的

桥本甲状腺炎已知与其他全身性自身免疫性疾病有关。已经描述了风湿表现，如血清阴性非侵蚀性多关节炎。本研究旨在评估甲状腺炎患者的风湿特征的特征和患病率，并确定与全身性自身免疫性疾病的关联是否改善了关节炎表现。

方法

共纳入 180 例甲状腺炎患者。记录主要临床和人口统计学特征。患者接受了风湿病学临床评估和关节外表现，以进行与全身性自身免疫性疾病和脊柱关节病的鉴别诊断。记录了全身性自身免疫性疾病的存在。

结果

甲状腺炎患者中共有 8.33%出现外周炎症性关节炎（P=0.002）。女性（P=0.042）和甲状腺过氧化物酶（TPOAbs）阳性（P=0.001）更为常见。共有 37 例患者患有全身性自身免疫性疾病（P=0.0003）。发现乳糜泻和艾迪生病的患病率显著较高（P=0.034 和 P=0.049）。在乳糜泻患者中，关节表现更为常见（21.21%）（P=0.001），发生关节受累的风险为 2.96。

结论

尽管我们发现约三分之一的甲状腺炎患者存在关节受累，但炎症性关节炎的患病率仅为 8.33%。其他共存自身免疫性疾病的患病率为 34.26%，乳糜泻的患病率显著较高（7.41%）。患有乳糜泻的甲状腺炎患者比没有乳糜泻的患者更频繁地出现关节受累。在这些患者中，我们发现关节炎的发病风险高于仅患有甲状腺炎的患者，这表明在发生关节受累时存在累积性自身免疫效应。