Waldenlind Kristin, Delcoigne Bénédicte, Saevarsdottir Saedis, Askling Johan
Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Department of Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.
J Intern Med. 2024 Mar;295(3):313-321. doi: 10.1111/joim.13743. Epub 2023 Nov 22.
Autoimmune thyroid disease (AITD) and rheumatoid arthritis (RA) share a genetic background, and the prevalence of AITD in RA patients is increased. Whereas immunomodulatory treatments are used in RA, they are rarely used in AITD.
We hypothesized that disease-modifying antirheumatic drugs (DMARDs) as used in RA might lower the risk of incident AITD.
A nationwide cohort study including 13,731 patients with new-onset RA from the Swedish Rheumatology Quality Register 2006-2018 and 63,201 matched general population comparators linked to national registers to identify AITD. We estimated relative risks (hazard ratios) of AITD after RA diagnosis in RA patients compared to the general population, and in relation to DMARD treatment, using Cox regression.
Following RA diagnosis, 321 (2.3%) of the RA patients and 1838 (2.9%) of the population comparators developed AITD, corresponding to an incidence of 3.7 versus 4.6 per 1000 person-years, hazard ratio, 0.81; 95% CI, 0.72-0.91. The decreased risk of incident AITD among RA patients compared to the general population was most pronounced among biologic DMARD (bDMARD) treated patients, with a hazard ratio of 0.54; 95% CI, 0.39-0.76. Among RA patients, subgrouped by bDMARD use, TNF-inhibitors were associated with the most pronounced decrease, hazard ratio, 0.67; 95% CI, 0.47-0.96.
In contrast to the increased prevalence of AITD in RA patients at diagnosis, our results indicate that the risk of AITD decreases following RA diagnosis. This decrease is especially pronounced in RA patients treated with bDMARDs. These findings support the hypothesis that DMARDs might have a preventive effect on AITD.
自身免疫性甲状腺疾病（AITD）与类风湿关节炎（RA）具有共同的遗传背景，且RA患者中AITD的患病率有所增加。虽然免疫调节治疗用于RA，但很少用于AITD。
我们假设用于RA的改善病情抗风湿药物（DMARDs）可能会降低发生AITD的风险。
一项全国性队列研究，纳入了瑞典风湿病质量登记处2006 - 2018年的13731例新发RA患者以及63201例匹配的普通人群对照者，并与国家登记处关联以确定AITD。我们使用Cox回归估计RA患者诊断为RA后发生AITD的相对风险（风险比），并与普通人群以及DMARD治疗情况进行比较。
RA诊断后，321例（2.3%）RA患者和1838例（2.9%）普通人群对照者发生了AITD，发病率分别为每1000人年3.7例和4.6例，风险比为0.81；95%置信区间为0.72 - 0.91。与普通人群相比，RA患者中发生AITD风险的降低在接受生物DMARD（bDMARD）治疗的患者中最为明显，风险比为0.54；95%置信区间为0.39 - 0.76。在按是否使用bDMARD分组的RA患者中，肿瘤坏死因子抑制剂与风险降低最为显著相关，风险比为0.67；95%置信区间为0.47 - 0.96。
与诊断时RA患者中AITD患病率增加相反，我们的结果表明RA诊断后AITD风险降低。这种降低在接受bDMARDs治疗的RA患者中尤为明显。这些发现支持了DMARDs可能对AITD具有预防作用的假设。
