Autoimmune thyroid disease risk decreases after rheumatoid arthritis diagnosis
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Key takeaways:
- Risk for autoimmune thyroid disease is lower for adults diagnosed with rheumatoid arthritis.
- Adults using antirheumatic drugs have further reductions in autoimmune thyroid disease risk.
Adults have a decreased risk for developing autoimmune thyroid disease after being diagnosed with rheumatoid arthritis, with the risk even lower for those receiving disease-modifying antirheumatic drugs, according to study data.
“The most pronounced decrease in risk was seen in rheumatoid arthritis patients treated with biologic disease-modifying antirheumatic drugs. In this group of patients, the risk of autoimmune thyroid disease was 46% lower than in the control group,” Kristin Waldenlind, MD, PhD, researcher in the department of medicine, division of clinical epidemiology at Karolinska Institutet in Sweden, told Healio. “These findings support the hypothesis that disease-modifying antirheumatic drugs might have a preventive effect on autoimmune thyroid disease.”
Waldenlind and colleagues collected data from 13,731 adults diagnosed with rheumatoid arthritis with a symptom duration of less than 1 year from 2006 to 2018 (64.7% women; mean age, 59.4 years). Adults with rheumatoid arthritis were matched with 63,201 people without rheumatoid arthritis. Incident autoimmune thyroid disease was identified if a participant filed a first prescription for a thyroid hormone substitution therapy. All data were obtained from nationwide Swedish health registers.
The findings were published in Journal of Internal Medicine.
Over a median follow-up of 6.3 years for those with rheumatoid arthritis and 6.4 years for the control group, 2.3% of the arthritis group and 2.9% of adults without rheumatoid arthritis developed autoimmune thyroid disease. Adults with rheumatoid arthritis had a lower risk for developing autoimmune thyroid disease than those without arthritis (adjusted HR = 0.81; 95% CI, 0.72-0.91).
Compared with the control group, the risk for developing autoimmune thyroid disease was more greatly reduced for adults receiving biologic disease-modifying antirheumatic drugs (HR = 0.54; 95% CI, 0.39-0.76), though adults not receiving antirheumatic drugs still had a lower risk for autoimmune thyroid disease compared with the general population (HR = 0.84; 95% CI, 0.74-0.96). Adults with rheumatoid arthritis who initiated biologic disease-modifying antirheumatic drugs had a lower risk for autoimmune thyroid disease than those with rheumatoid arthritis who did not use antirheumatic drugs (HR = 0.65; 95% CI, 0.45-0.93).
“Our hypothesis was that disease-modifying antirheumatic drugs used in rheumatoid arthritis might lower the risk of new-onset autoimmune thyroid disease, but the risk reduction was to some extent more pronounced than expected,” Waldenlind said.
In subgroup analysis examining only adults with rheumatoid arthritis, those who were younger than 40 years and received antirheumatic drugs had a lower risk for autoimmune thyroid disease than those who did not use an antirheumatic drug (HR = 0.46; 95% CI, 0.21-0.98). The risk for autoimmune thyroid disease was lower for adults who received concomitant methotrexate compared with those not receiving an antirheumatic drug (HR = 0.64; 95% CI, 0.42-0.96). Adults receiving tumor necrosis factor (TNF) inhibitors had a lower risk for autoimmune thyroid disease than those not receiving a biologic disease-modifying antirheumatic drug (HR = 0.67; 95% CI, 0.47-0.96). No decreased risk for autoimmune thyroid disease was observed for other antirheumatic drug classes.
“If further studies support these findings, it opens up to more direct study in clinical trials if disease-modifying antirheumatic drugs currently used for rheumatoid arthritis could also be used for the early treatment of autoimmune thyroid disease,” Waldenlind said.
For more information:
Kristin Waldenlind, MD, PhD, can be reached at kristin.waldenlind@ki.se.
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