Association and Similarities between Undifferentiated Connective Tissue Diseases and Autoimmune Thyroid Diseases

Yıl 2019, Cilt: 19 Sayı: 3, 571 - 581, 30.09.2019

Funda Erbasan

https://doi.org/10.17098/amj.624524

Öz

Objectives: Autoimmune thyroid diseases (ATDs) can be
accompanied by systemic autoimmune diseases. The aim of this study was to
determine the association, similarities, and differences between
undifferentiated connective tissue diseases (UCTDs) and ATDs.

Materials and Methods: Fifty nine UCTD
patients and 108 control subjects were retrospectively evaluated. Thyroid
function tests, antithyroid antibodies, antinuclear antibody (ANA), anti-double
stranded deoxyribonucleic acid and anti-extractable nuclear antigens peptide
levels, and histopathological examination of the minor salivary gland were
evaluated.

Results: The prevalence of ATD
was 23.70% and 33.30% in the UCTD and control groups, respectively (p = 0.220).
The prevalence of arthritis in isolated UCTD patients was 11.10%, which was
significantly increased (35.70%) if UCTD was accompanied by a ATD (p = 0.047).
Other clinical symptoms such as arthralgia, xerostomia, keratoconjunctivitis
sicca, Raynaud’s phenomenon, oral aphthous ulcers, and photosensitivity
observed in UCTD, ANA positivity rates, and the most common staining pattern
(speckled) were similar between the ATD and non-ATD patients. Histopathological
examination of the minor salivary gland in 9 ATD patients revealed no
significant lymphocyte infiltration. In the comparison of UCTD and ATD
patients, the findings were similar, except arthralgia and ANA positivity,
which were higher in UCTD patients.

Conclusion: As a result,
considering similar clinical symptoms and autoimmune profiles of UCTD and ATD,
it is recommended to make a clear differential diagnosis of both diseases in
patients presenting with complaints such as arthralgia, xerostomia, and
Raynaud’s phenomenon.

Anahtar Kelimeler

Undifferentiated connective tissue disease, autoimmune thyroid disease, antithyroid antibodies, antinuclear antibody, ,

Undifferansiye Bağ Doku Hastalıkları ve Otoimmün Tiroid Hastalıklarının Birlikteliği ve Benzerlikleri

Öz

Amaç: Otoimmün tiroid hastalıkları (OTH) sistemik
otoimmün hastalıklara eşlik edebilmektedirler. Bu çalışmanın amacı
Undifferansiye Bağ Doku Hastalıkları (UBDH) ve OTH hastalıkları arasındaki
ilişkiyi, benzerlikleri ve farklılıkları saptamaktır.

Materyal ve Metot: Çalışmaya 59 UDBH hastası ve 108 kişilik kontrol
grubu alındı. Tiroid fonksiyon testleri, antitiroid antikorları, antinükleer
antikorlar (ANA), anti-dsDNA ve ekstrakte edilebilen nükleer antijenlere karşı
gelişen antikorların seviyeleri ile minör tükürük bezinin histopatolojik
incelemesi değerlendirildi.

Bulgular: OTH prevalansı UDBH grubunda %23,70, kontrol grubunda ise %33,30
olarak bulundu (p=0,220). İzole UDBH’da artrit görülme oranı %11,10 iken, OTH
ile birlikteliği durumunda bu oranın %35,70 olarak anlamlı derecede artmış
olduğu saptandı (p=0,047). UDBH da görülen artralji, xserostomi,
keratokonjuktivitis sikka, raynaud, oral aft ve fotosensitivite gibi diğer
klinik belirtiler, ANA pozitiflik oranları ve en sık görülen boyanma paterni
benekli olmak üzere OTH olan ve olmayanlarda benzerdi. OTH bulunan 9 hastanın
yapılan minör tükrük bezinin histopatolojik incelemesinde anlamlı bir lenfosit
infiltrasyonu izlenmedi. Tek başına UDBH ile OTH olan hastalar
karşılaştırıldığında, UDBH’da daha yüksek oranda görülen artralji ve ANA
poziftiliği dışında diğer bulgular benzerdi.

Sonuç: Sonuç olarak, UDBH ile OTH klinik belirtileri ve otoimmün
profilinin büyük oranda benzer olduğu göz önüne alınarak artralji, xserotomi,
raynaud gibi yakınmalar ile gelen hastalarda her 2 hastalığın ayırıcı tanısının
iyi yapılması ve ayrıca bu iki hastalığın birlikte bulunabileceğininde
gözününde tutulması önerilir.

Anahtar Kelimeler

Undiferansiye bağ doku hastalığı, otoimmün tiroid hastalığı, antitiroid antikor, antinükleer antikor

Kaynakça

• Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine 2004;71:275-83.
• Weetman AP. Non-thyroid autoantibodies in autoimmune thyroid disease. Best Pract Res Clin Endrocrinol Metab 2005;19:17-32.
• Soy M, Guldiken S, Arikan E, Altun BU, Tugrul A. Frequency of rheumatic disease in patients with autoimmune thyroid disease. Rheumatol Int 2007;27:575-7.
• Weetman AP, McGregor AM. Autoimmnune thyroid disease: further developments in our understanding. Endocr Rev 1994;15:788-830.
• Elnady BM, Kamal NM, Shaker RH et al. Prevalence and clinical significance of nonorgan specific antibodies in patients with autoimmune thyroiditis as predictor markers for rheumatic diseases. Medicine (Baltimore) 2016;95:e4336.
• Golding DN. Rheumatism and the thyroid. J R Soc Med 1993; 86:130-2. (PMID: 8459372)
• Punzi L, Sfriso P, Pianon M et al. Clinical manifestations and outcome of polyarthralgia associated with chronic lymphocytic thyroiditis. Semin Arthritis Rheum 2002;32:51-5.
• LeRiche NG, Bell DA. Hashimoto’s thyroiditis and polyarthritis: A possible subset of seronegative polyarthritis. Ann Rheum Dis 1984;43:594-8.
• Mosca M, Tani C, Carli L, Bombardieri S. Undifferentiated CTD: A wide spectrum of autoimmune diseases. Best Pract Res Clin Rheumatol 2012;26(1):73-7. Mosca M, Tani C, Neri C, Baldini C, Bombardieri S. Undifferentiated connective tissue diseases (UCTD). Autoimmun Rev 2006;6:1-4.
• D. M. Cisholm and D. K. Mason. Labial salivary gland biopsy in sjogren’s syndrome. J Clin Path 1968;21:656-60.
• Danieli MG, Rossetti L, Fraticelli P Malcangi G, Testa I, Danieli G. Autoimmune thyroid diseases in patients with undifferentiated connective tissue disease. Clin Rheumatol 2000;19:42-6.
• Tagoe CE, Zezon A, Khattri S, Castellanos P. Rheumatic manifestations of euthyroid, anti-thyroid antibody-positive patients. Rheumatol Int 2013;33:1745-52.
• Gillan MM, Scofield RH, Harley JB. Hashimoto’s thyroiditis presenting as bilateral knee arthropathy. J Okla State Med Assoc 2002;95:323-5.
• Bland JH, Frymoyer JW, Newberg AH, Revers R, Norman RJ. Rheumatic syndromes in endocrine disease. Semin Arthritis Rheum 1979;9:23-65.
• Bland JH, Frymoyer JW, Newberg AH, Revers R, Norman RJ. Rheumatic syndromes in endocrine disease. Semin Arthritis Rheum 1979;9:23-65.
• Milic VD, Radunovic G, Boricic I, Ognjanovic S, Petrovic R, Radak-Perovic M et al. High prevalence of autoimmune thyroid disease in subjects with sicca symptoms without Sjogren's syndrome. Rheumatology (Oxford) 2013;52:754-5.
• Changlai SP, Chen WK, Chung C, Chiou SM. Objective evidence of decreased salivary function in patients with autoimmune thyroiditis (chronic thyroiditis, Hashimoto’s thyroiditis). Nucl Med Commun 2002;23:1029-33.
• Chang CP, Shiau YC, Wang JJ, Ho ST, Kao CH. Decreased salivary gland function in patients with autoimmune thyroiditis. Head Neck 2003;25:132-7.
• Agha-Hosseini F, Shirzad N, Moosavi MS. Evaluation of Xerostomia and salivary flow rate in Hashimoto’s Thyroiditis. Med Oral Patol Oral Cir Bucal 2016;1;21:e1-5.
• Warfvinge G, Larsson A, Henricsson V, Ericsson UB, Hansen B, Manthorpe R. Salivary gland involvement in autoimmune thyroiditis, with special reference to the degree of association with Sjögren's syndrome. Oral Surg Oral Med Oral Pathol 1992;74:288-93.
• Kan E, Kılıçkan E, Ecemiş G, Beyazyildiz E, Çolak R. Presence of Dry Eye in Patients with Hashimoto's Thyroiditis. J Ophthalmol 2014:754923. http://dx.doi.org/10.1155/2014/754923, Date of Access: 01.03.2019.
• Lazúrová I, Benhatchi K, Rovenský J et al. Autoimmune thyroid disease and autoimmune rheumatic disorders: a two-sided analysis. Ann N Y Acad Sci 2009;1173:211-6.
• Coll J, Anglada J, Tomas S et al. High prevalence of subclinical Sjögren’s syndrome features in patients with autoimmune thyroid disease. J Rheumatol 1997;24:1719-14.
• Nisihara R, Pigosso YG, Prado N, Utiyama SRR, De Carvalho GA, Skare TL. Rheumatic Disease Autoantibodies in Patients with Autoimmune Thyroid Diseases. Med Princ Pract 2018;27:332-6.