Psöriatik artrit hastalarında otoimmun tiroid hastaliği sıklığı ve anti TNF-a tedavisinin etkisi

Yıl 2020, Cilt: 45 Sayı: 2, 461 - 467, 30.06.2020

Ümit Karaoğullarından Emine Tarhan Güzide Gonca Örük

https://doi.org/10.17826/cumj.669775

Öz

Amaç: Bu çalışmada psöriatik artrit (PsA) hastalarında tiroid hastalığı sıklığı ve anti-TNF tedavinin otoimmun tiroid hastalığına olan etkisi araştırılmıştır..
Gereç ve Yöntem: Romatoloji polikliniğinde PsA tanısıyla takip edilen 95 hastanın tiroid stimülan hormonu (TSH), triiyodotironin (sT3), tiroksin (sT4), antitiroglobulin (Tg) ve anti-tiroid peroksidaz (TPO) retrospektif olarak incelendi. Çalışmaya, verileri eksiksiz olan ve tiroid hastalığına yol olan sekonder nedeni olmayan 66 adet PsA (F / M: 43/23) ve 35 sağlıklı kontrol (F / M: 25/10) alındı. Tüm olgulara endokrinoloji uzmanı tarafından tiroid ultrasonografisi yapıldı.
Bulgular: PsA hastalarından 38 tanesi hastalık modifiye edici antiromatizmal ajan (DMARD) tedavisi (Grup 1; ortalama yaş: 43.94 ± 9.81) ve 28 hasta anti-TNF-α tedavisi (Grup 2; ortalama yaş: 42.25 ± 11.48) alıyordu. Grup 3 sağlıklı kontrollerden oluşuyordu (yaş ortalaması: 40,52 ± 8,34). Tüm grupların ortalama anti-TPO değerleri ve anti-Tg değerleri arasında anlamlı farklılıklar gözlendi.
Sonuç: PsA hastalarında otoimmün tiroid bozuklukları kontrol grubundan daha sık gözlendi. DMARD alan PsA hastalarında anti-TNF-α tedavisi alan hastalardan daha sık otoimmün tiroid bozuklukları görüldü. Bu durum tiroid bozukluklarının patogenezinde TNF-α nın rolü olabileceğini gösterdi.  

Anahtar Kelimeler

psoriatic arthritis, anti-TNF

Frequency of autoimmune thyroid disorders in patients with psoriatic arthritis and effect of anti-TNF alpha treatment

Öz

Purpose: In this study, the frequency of thyroid disorders in psöriatic arthritis (PsA) patients and the effect of anti TNF-α treatment on autoimmune thyroid disease were investigated.
Materials and Methods: Thyroid stimulating hormone, triiodothyronine, thyroxine, antithyroglobulin(Tg) and anti-thyroid peroxidase (TPO) of 95 patients followed at the rheumatology outpatient clinic were retrospectively evaluated. Sixty-six patients with PsA (F/M: 43/23) whose data were complete, and 35 healthy controls (F/M: 25/10) were included in the study. Thyroid ultrasonography was applied to all cases by an endocrinology specialist.
Results :38 of the PsA patients received disease modifying antirheumatic drugs (DMARDs) (Group 1; mean age: 43.94±9.81), and 28 anti TNF-α treatment (Group 2; mean age:42.25±11.48). Group 3 was comprised of healthy controls (mean age: 40.52±8.34). Significant differences were observed between the mean anti-TPO values and anti-Tg values of all groups.
Conclusion:: Autoimmune thyroid disorders were observed more frequently in patients with PsA than in the control group. The PsA patients who are receiving DMARDs appeared to have autoimmune thyroid disorders more frequently than those receiving anti TNF-α treatment. This condition may be resulting from TNF-α on the pathogenesis of thyroid disorders. 

Anahtar Kelimeler

Psoriatic arthritis, anti-TNF, thyroid dysfunction

Kaynakça

• 1.Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 Suppl 2:ii14.
• 2.Ritchlin CT, Kavanaugh A, Gladman DD, et al. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis 2009; 68:1387.
• 3. Wright V, Moll JM. Psoriatic arthritis. Bull Rheum Dis 1971; 21:627.
• 4.Queiro-Silva R, Torre-Alonso JC, Tinturé-Eguren T, López-Lagunas I.A polyarticular onset predicts erosive and deforming disease in psoriatic arthritis. Ann Rheum Dis 2003; 62:68. 5. Brockbank J, Gladman D. Diagnosis and management of psoriatic arthritis. Drugs 2002; 62:2447.
• 6.Wright V, Moll JM. Psoriatic arthritis. Bull Rheum Dis 1971; 21:627.
• 7.Gladman DD: Toward unravelling the mystery ofpsoriatic arthritis.Arthritis Rheum 36:881,1993.
• 8.Espinoza LR,Aguilar JL,Espinoza CG,et al:Fibroblast function in psoriatic arthritis.I.Alteretion of cell kinetics and grow factor responses.J Rheumatol 21:1502,1994.
• 9.Frraser A,Fearon U,Reece R,et al:Matrix metalloproteinase 9,apoptosis and vascular morphology in early arthritis.Arthritis Rheum 44:2024-2028,2001
• 10.Ritchlin C,Haas-Smith SA,Schwartz E:Osteoclast precursors are markedly increased in the peripheral blood ofpsoriatic arthritis patients. .Arthritis Rheum 44(supply 9):S325,2001.
• 11.Espinoza LR,Jara LJ,Espinoza CG,et al:There is an association between human immunodeficiency virüs infection and spondyloartropathies.Rheum DisClin North Am 18:257,1997.
• 12. Harvey A.R.,Champe C.P.,Lıppıncot’s Illustrated series 2007;3:245
• 13. Michalek K, Morshed SA, Latif R, Davies TF. TSH receptor autoantibodies. Autoimmun Rev 2009; 9:113.
• 14.Biró E, Szekanecz Z, Czirják L, Dankó K, Kiss E, Szabó N, Szücs G, Zeher M, Bodolay E, Szegedi G, Bakó G (2006) Association of systemic and thyroid autoimmune diseases. Clin Rheumatol 25:240– 245
• 15.Scofield RH, Bruner GR, Harley JB, Namjou B (2007) Autoimmune thyroid disease is associated with a diagnosis of secondary Sjögren’s syndrome in familial systemic lupus. Ann Rheum Dis 66:410–413
• 16. Boey ML, Fong PH, Long PH, Lee JSC, Ng WY, Thaı AC (1993) Autoimmune thyroid disorders in SLE in Singapore. Lupus 2:51–54
• 17.El-Sherif WT, El Gendi SS, Ashmawy MM, Ahmed HM, Salama MM (2004) Thyroid disorders and autoantibodies in systemic lupus erythematosus and rheumatoid arthritis patients. Egypt J Immunol 11(2):81–90
• 18.Goh KL, Wang F (1986) Thyroid disorders in systemic lupus erythematosus. Ann Rheum Dis 45:579–583
• 19. Wassen FW, Moerings EP, Van Toor H, De Vrey EA, Hennemann G, Everts ME. Effects of interleukin-1 beta on thyrotropin secretion and thyroid hormone uptake in cultured rat anterior pituitary cells. Endocrinology. 1996;137:1591–1598.
• 20. Kennedy JA, Wellby ML, Zotti R. Effect of interleukin-1 beta, tumour necrosis factor-alpha and interleukin-6 on the control of thyrotropin secretion. Life Sci. 1995;57:487–501.
• 21. Diez JJ, Hernanz A, Medina S, Bayon C, Iglesias P. Serum concentrations of tumour necrosis factor-alpha (TNF-alpha) and soluble TNF-alpha receptor p55 in patients with hypothyroidism and hyperthyroidism before and after normalization of thyroid function. Clin Endocrinol (Oxf) (2002) 57:515–21.10.1046/j.1365-2265.2002.01629.
• 22. T.F. Tsai, C.H. Lee, Y.H. Huang, et al.Taiwanese Dermatological Association consensus statement on management of psoriasis. Dermatol Sin 2017, 35, pp. 66-77.
• 23. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med 1996, 335:99–107.
• 24. Pérez B, Kraus A, López G, Cifuentes M, Alarcón-Segovia D. Autoimmune thyroid disease in primary Sjogren’s syndrome. Am J Med 1995, 99:480–484.
• 25. Scofield RH. Autoimmune thyroid disease in systemic lupus erythematosus and Sjogren’s syndrome. Clin Exp Rheumatol 1996, 14: 321–330.
• 26. Chan AT, Al-Saffar Z, Bucknall RC. Thyroid disease in systemic lupus erythematosus and rheumatoid arthritis. Rheumatology 2001, 40:353–354.
• 27. Pyne D, Isenberg DA. Autoimmune thyroid disease in systemic lupus erythematosus. Ann Rheum Dis 2002,61:70–72.
• 28. T.F. Tsai, T.S. Wang, S.T. Hung, et al.Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan. J Dermatol Sci, 2011, 63, pp. 40-46.
• 29. A. Zoabi, M. Ziv, D. Fau - Rozenman, R. Rozenman D Fau - . Lovoshitski, Prevalence of thyroid abnormalities among psoriatic patients. Harefuah, 2012, 151, pp. 566-569.
• 30. E. Vassilatou, E. Papadavid, P. Papastamatakis, et al.No association of psoriasis with autoimmune thyroiditis. J Eur Acad Dermatol Venereol, 2017, 31, pp. 102-106.
• 31. Durham LE, Taams LS, Kirkham BW. Psoriatic arthritis. Br J Hosp Med (Lond) 2016 77:C102–8.
• 32. Bianchi G, Marchesini G, Zoli M, Falasconi MC, Iervese T, Vecchi F, et al. Thyroid involvement in chronic inflammatory rheumatological disorders. Clin Rheumatol 1993 12:479–84.
• 33. Antonelli A, Delle Sedie A, Fallahi P, et al. High prevalence of thyroid autoimmunity and hypothyroidism in patients with psoriatic arthritis. J Rheumatol 2006; 33:2026.
• 34. Soy M, Guldiken S, Arikan E, Altun BU, Tugrul A. Frequency of rheumatic diseases in patients with autoimmune thyroid disease. Rheumatol Int 2007 27:575–7.
• 35. Unsal E, Oren O, Salar K, Makay B, Abaci A, Ozhan B, et al. The frequency of autoimmune thyroid disorders in juvenile idiopathic arthritis. Turk J Pediatr 2008 50:462–5.
• 36. Vassilatou E, Papadavid E, Papastamatakis P, Alexakos D, Koumaki D, Katsimbri P, et al. No association of psoriasis with autoimmune thyroiditis. J Eur Acad Dermatol Venereol 2017 31:102–6.
• 37. Ferrari SM, Ruffilli I, Colaci M, Antonelli A, Ferri C, Fallahi P. CXCL10 in psoriasis. Adv Med Sci 2015 60:349–54.
• 38. Fallahi P, Ferrari SM, Ruffilli I, Elia G, Miccoli M, Sedie AD, et al. Increased incidence of autoimmune thyroid disorders in patients with psoriatic arthritis: a longitudinal follow-up study. Immunol Res 2017 65:681–6.
• 39. Antonelli A, Fallahi P, Delle Sedie A, Ferrari SM, Maccheroni M, Bombardieri S, et al. High values of Th1 (CXCL10) and Th2 (CCL2) chemokines in patients with psoriatic arthritis. Clin Exp Rheumatol. 2009;27:22–7.
• 40. Antonelli A, Fallahi P, Delle Sedie A, Ferrari SM, Maccheroni M, Bombardieri S, et al. High values of alpha (CXCL10) and beta (CCL2) circulating chemokines in patients with psoriatic arthritis, in presence or absence of autoimmune thyroiditis. Autoimmunity. 2008;41:537–4.
• 41. Tan JK, Aphale A, Malaviya R, Sun Y, Gottlieb AB. Mechanisms of action of etanercept in psoriasis. J Investig Dermatol Symp Proc. 2007;12:38–45.
• 42. Tarhan F, Oruk G, Niflioglu O, Ozer S. Thyroid involvement in ankylosing spondylitis and relationship of thyroid dysfunction with anti-TNF treatment. Rheumatol Int 2013, 33:853–857.
• 43. Allanore Y, Bre´mont C, Kahan A, Menke`s CJ (2001) Transient hyperthyroidism in a patient with rheumatoid arthritis treated by etanercept. Clin Exp Rheumatol 19(3):356–357.
• 44. Van Lieshout AW, Creemers MC, Radstake TR, Elving LD, Van Riel PL (2008) Graves’ disease in a patient with rheumatoid arthritis during treatment with anti-tumor necrosis factor-alpha. J Rheumatol 35(5):938–939. 45. Chen K, Wei Y, Sharp GC, Braley-Mullen H (2007) Decreasing TNF-alpha results in less fibrosis and earlier resolution of granulomatous experimental autoimmune thyroiditis. J Leukoc Biol 81(1):306–314.
• 46. Raterman HG, Jamnıtskı A, Lems WF, Voskuyl AE, Dıjkmans BA, Bos WH, Simsek S, Lıps P, Van de Stadt RJ, de Koning MH, Nurmohamed MT (2011) Improvement of thyroid function in hypothyroid patients with rheumatoid arthritis after 6 months of adalimumab treatment: a pilot study. J Rheumatol 38(2):247–251 .
• 47. Sabugo F, Liberman C, Niedmann JP, Soto L, Cuchacovich M (2008) Infliximab can induce a prolonged clinical remission and a decrease in thyroid hormonal requirements in a patient with SAPHO syndrome and hypothyroidism. Clin Rheumatol 27(4):533–535.
• 48. Mazzaferi EI (1993) Management of solitary thyroid nodule. N Engl J Med 328:553–559
• 49. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22:901-911.
• 50. Terlemez R, Akgün K, Palamar D, Boz S, Sarı H. The clinical importance of the thyroid nodules during anti-tumor necrosis factor therapy in patients with axial spondyloarthritis. Clin Rheumatol. 2017 May;36(5):1071-1076.