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Thyroid abnormalities common in juvenile arthritis, rheumatic fever
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Children and adolescents with rheumatic fever or juvenile arthritis are prone to autoimmune thyroid disorders and would benefit from routine screening, according to recent results.
In a cross-sectional study in Brazil, researchers evaluated the thyrotropin (TSH), triiodothyronine (T3), free thyroxine (FT4), antithyroglobulin (Tg), antiperoxidase (TPO) and IgA antitransglutaminase (tTG) antibodies in 53 patients (mean age, 10.4 years) with juvenile idiopathic arthritis (JIA), 66 with rheumatic fever (RF) (mean age, 11.5 years) and 40 matched healthy controls (18 for the JIA; 22 for the RF group). Levels of fasting glucose, C-peptide, anti-islet cell (IA) and antiglutamic acid decarboxylase (GAD) also were measured.
Among those with JIA, 40% of cases, including 42% of those with oligoarticular JIA, had thyroid disorders, including subclinical hypothyroidism (13% of cases) and the presence of antithyroid antibodies (26% of cases, 50% of those with oligoarticular JIA) (OR=10.5; 1.29-85.2 compared with controls). One control for this group had anti-Tg and TPO antibodies, with normal thyroid ultrasound and levels of TSH, FT4 and T3. Analysis of each thyroid abnormality separately indicated no significant differences between controls and patients with JIA.
Thyroid disorders were observed in 11 RF patients, including seven with positive anti-thyroid antibodies and four with subclinical hypothyroidism. No overt hypothyroidism was observed, and no controls for this group exhibited thyroid abnormalities or tested positive for antibodies (P=.06 for difference).
One patient in each group was diagnosed with asymptomatic celiac disease (CD) after small intestinal biopsy. Both patients tested positive for IgA tTG antibodies, and neither had a family history of either CD or autoimmune disease.
“The present study found a significant prevalence of autoimmune thyroid disorders in patients with RF and JIA, especially in the oligoarticular subtypes, suggesting that routine screening for thyroid diseases in this group must be considered,” the researchers wrote. “The identification of two asymptomatic cases of CD emphasizes the need for health professionals to be attentive toward atypical and oligosymptomatic forms of the disease, which can often manifest themselves in ways similar to rheumatic diseases.”
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