Zohaib Amer, Rasheed Aflak, Mahmud Tafazzul-E-Haque, Hayat Umar, Shabbir Sumayya, Riaz Saima, Jamil Muhammad Zahid Z, Javaid Umair
Rheumatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, PAK.
Nephrology, Jinnah Hospital, Lahore, PAK.
Cureus. 2022 Jun 27;14(6):e26382. doi: 10.7759/cureus.26382. eCollection 2022 Jun.
Introduction Rheumatoid arthritis (RA) is a chronic autoimmune disorder with variable disease course including periods of flares and remissions. High disease activity in terms of disease activity score-28 (DAS-28) results in significant morbidity. Hypothyroidism is found to be associated with higher DAS-28 scores in RA. This study is planned to determine overt and subclinical hypothyroidism and its correlation with the DAS-28 score in patients with RA. Methodology This study was conducted from June 2021 to March 2022 at the department of rheumatology and immunology at Shaikh Zayed Hospital, Lahore, Pakistan. Inclusion criteria were any male and female patients aged between 18 and 70 years. The blood samples of diagnosed patients with RA were sent for thyroid function tests (thyroxine [FT4], thyroid-stimulating hormone [TSH]), and erythrocyte sedimentation rate (ESR), and the patients were categorized as overt hypothyroidism, subclinical hypothyroidism, and non-hypothyroid. The collected data were analyzed on Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY). Results The mean age of patients was 38.18 ± 9.78 years. The mean duration of symptoms was 14.65 ± 1.04 months. There were 182 (91%) females and 18 (9%) males. The mean number of swollen joints was 2.26 ± 2.8, and the mean number of tender joints was 4.16 ± 5.11. Sixty patients (30%) had high disease activity, i.e., DAS-28 score > 5.1. Fifty-seven patients (28.5%) with RA had subclinical hypothyroidism, and 19 patients (9.5%) had overt hypothyroidism. Pain visual analog scale (VAS) and DAS-28 were significantly higher in hypothyroid patients. Conclusion It was concluded that patients of RA with concomitant hypothyroidism had increased disease activity with increased tender joints. Thyroid function tests should be included in the clinical evaluation of RA patients. The evaluation of thyroid functional status must be done during screening in RA patients. This will detect thyroid disorders earlier, with early treatment initiation and possibly a better prognosis.
引言
类风湿关节炎（RA）是一种慢性自身免疫性疾病，病程多变，包括病情发作期和缓解期。疾病活动度评分-28（DAS-28）显示的高疾病活动度会导致显著的发病率。研究发现甲状腺功能减退与类风湿关节炎患者较高的DAS-28评分相关。本研究旨在确定类风湿关节炎患者的显性和亚临床甲状腺功能减退及其与DAS-28评分的相关性。
方法
本研究于2021年6月至2022年3月在巴基斯坦拉合尔谢赫扎耶德医院的风湿病与免疫学系进行。纳入标准为年龄在18至70岁之间的任何男性和女性患者。将确诊为类风湿关节炎患者的血样送去进行甲状腺功能检查（游离甲状腺素[FT4]、促甲状腺激素[TSH]）和红细胞沉降率（ESR）检查，并将患者分为显性甲状腺功能减退、亚临床甲状腺功能减退和非甲状腺功能减退组。收集的数据在社会科学统计软件包（SPSS）24.0版（IBM公司，纽约州阿蒙克）上进行分析。
结果
患者的平均年龄为38.18±9.78岁。症状的平均持续时间为14.65±1.04个月。有182名（91%）女性和18名（9%）男性。肿胀关节的平均数量为2.26±2.8个，压痛关节的平均数量为4.16±5.11个。60名患者（30%）疾病活动度高，即DAS-28评分>5.1。57名（28.5%）类风湿关节炎患者有亚临床甲状腺功能减退，19名（9.5%）有显性甲状腺功能减退。甲状腺功能减退患者的疼痛视觉模拟量表（VAS）和DAS-28评分显著更高。
结论
得出的结论是，合并甲状腺功能减退的类风湿关节炎患者疾病活动度增加，压痛关节增多。类风湿关节炎患者的临床评估应包括甲状腺功能检查。在类风湿关节炎患者筛查期间必须进行甲状腺功能状态评估。这将更早地发现甲状腺疾病，更早开始治疗，并可能有更好的预后。
