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ROMATOİD ARTRİTTE TİROİD FONKSİYON TESTLERİ VE HASTALIK AKTİVİTESİ İLE İLŞiKİSİ

THYROID FUNCTION TESTS AND THEIR RELATION TO DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2007

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective: The aim of this study was to evaluate of the frequency of anti-thyroid antibodies, thyroid fuctions and their relation to disease activity in patients with rheumatoid arthritis (RA). Materials and methods: Thirty-seven (female/male: 32/5) newly diagnosed patients with RA and 23 (female/male: 19/4) healthy controls were included in the study. All the patients fulfilled 1987 ACR criteria. None of the patients in the study or control group had a history of thyroid disease, thyroidectomy or drug use related to thyroid.Physical examination of the thyroid was performed in all the patients in addition to DAS28 score calculation. Levels of TSH, fT3, fT4, tT3, tT4, antithyroglobulin antibodies (ATA), antimicrosomal antibodies (AMA), ANA, ESR, CRP were deterimed in all the patients. Results: The mean age of the patients with RA and the controls was 51.4 ± 11.8 (21-75) years and 40.9 ± 13.8 (20- 73), respectively. The mean duration of disease in the RA group was 11.0 ± 9.7 (1-45) years. The rheumatoid factor was positive in 24 patients (67 %). Although in the normal range, the thyroid-stimulating hormone was significantly lower in patients with RA than that in the controls (1.1±0.9 mIU/ml and 1.6±1.0 mIU/ml, respectively, p<0.05). In 5 patients with RA (%13), the TSH level was below the lower limit of the normal range. In the RA group, the levels of free T3(fT3), free T4(fT4), total T3(tT3) and total T4 (tT4) were 3.3±0.7 pg/ml, 2.6±4.0 ng/dl, 97.8±40.7 ng/dl and 8.9±1.8 mg/dl, respectively; there was no significant difference in their levels between the two groups. The mean eryhtrocyte sedimentation rate (ESR) was 39.2 ± 31.5 mm/h (3-120) in the RA group; there was no correlation between ESR and TSH, fT3, FT+, fT4, and tT4. To evaluate disease activity, DAS28 score was calculated, which was 4.5 ± 1.4 (1.5-7.1; median 4.7) in the RA group. DAS28 score correlated only with tT3 (p<0.05). Antithyroglobulin antibody (ATA) and antimicrosomal antibody (AMA) were analysed in 30 patients with RA and in all controls. ATAwas found to be positive in 5 patients with RA (16.6%) and in all controls (13%) which did not differ significantly between the two groups. AMAwas positive in 6 patients (20%) with RA and in 2 controls (8.6%) without statistical difference. Antinuclear antibodies could be detected in none of the individuals in the RA and control group. Conclusion: Positivity for autoantibodies and thyroid function alterations may be observed in RA which may be related to disease activity. The thyroid dysfunction associated with RA is usually seen in the form of non-thyroidal illness syndrome or subclinical hyperthyroidism. Therefore we suggest that thyroid function should be evaluated carefully in patients with RA, and thyroid hormon levels should be monitored regularly during follow up.
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Abstract (Original Language): 
Amaç: Bu çal›flman›n amac›; Romatoid artrit (RA)’li hastalarda anti-tiroid antikor s›kl›¤›n›n saptanmas›, tiroid fonksiyonlar›n›n de¤erlendirilmesi ve hastal›k aktivitesi ile iliflkisinin araflt›r›lmas›. Gereç ve yöntem: Romatoloji Poliklini¤i’ne ilk kez baflvuran ve 1987 ACR s›n›fland›rma kriterlerine göre RA tan› s› konulan 37 hasta (K/E:32/5) ile 23 sa¤l›kl› kontrol (K/E:19/4) çal›flmaya al›nd›. Hastalar›n ve kontrollerin hiçbirinde tiroid hastal›¤›, tiroid operasyonu hikayesi yoktu ve tiroid fonksiyonlar›n› etkileyecek bir ilaç kullanm›yorlard›. Tüm hastalara tiroid muayenesi yap›ld› ve DAS28 skoru hesapland›; TSH, sT3, sT4, tT3, tT4, antitiroglobulin antikoru (ATA) ve antimikrozomal antikor (AMA), ANA, ESH, CRP bak›ld›. Bulgular: RA’l› hastalarda ortalama yafl 51,4±11,8 (21-75 aras›), ortalama hastal›k süresi 11,0±9,7 y›l (1-45) iken sa¤l›kl› kontollerde ortalama yafl 40,9±13,8 (20-73 aras›) bulundu. Hastalar›n 24’ünde (%67) RF pozitif idi. TSH düzeyleri RA grubunda kontrollere göre anlaml› olarak daha düflüktü fakat normal s›n›rlar içindeydi (s›ras›yla 1,1±0,9 mIU/ml ve 1,6±1,0 mIU/ml, p<0.05). RA’l› hastalar›n 5’inde (%13) TSH düzeyleri normalin alt›nda idi. RA’l› hastalarda serbest T3 (sT3), serbest T4 (sT4), total T3 (tT3) ve total T4 (tT4) düzeyleri s›ras›yla 3,3±0,7 pg/ml, 2,6±4,0 ng/dl, 97.8±40.7 ng/dl ve 8,9±1,8 mg/dl olarak bulundu; kontrol grubuyla karfl›laflt›r›ld›¤›nda aradaki fark istatistiki olarak anlaml› de¤ildi. RA grubunda ESH ortalama 39,2±31,5 mm/s (3-120 aras›) olup ESH düzeyleri ile TSH, sT3, sT4, tT3, tT4 de¤erleri aras›nda korelasyon saptanmad›. Hastal›k aktivitesini de¤erlendirmek için DAS28 skoru hesapland›. DAS28 skoru ortalama 4,5±1,4 (1,5-7,1 aras›, medyan 4,7) bulundu. DAS28 skoru ile sadece tT3 de¤erleri aras›nda korelasyon saptand› (p<0,05). ATA, RA ve kontrol grubunda s›ras›yla 5 (%16,6) ve 3 (%13) olguda pozitif olup aradaki fark anlaml› de¤ildi. RA grubunda 6 (%20) ve kontrol grubunda 2 (%8,6) olguda AMA pozitif bulundu; aradaki fark anlaml› de¤ildi. Hasta ve kontrollerin hiçbirinde ANA pozitifli¤i saptanmad›. Sonuç: RA’da tiroid fonksiyon testlerinde de¤ifliklikler ve otoantikor pozitiflikleri görülebilmektedir ve bu durum hastal›k aktivitesi ile iliflkili olabilmektedir. RA’da tiroid disfonksiyonu genellikle nontiroidal hastal›k sendromu ve subklinik hipertiroidi fleklinde görülmektedir. Bu nedenle, RA’l› hastalarda tiroid disfonksiyonu aç›s›ndan dikkatli olunmas› ve belli aral›klarla hormon düzeylerinin kontrol edilmesi uygun olacakt›r.
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  • 4
103-106
  • Turkish

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