Categories:

Arthritis and Hypothyroidism

Also see:
Hormone Balancing: Natural Treatment and Cure for Arthritis

Folia Med (Plovdiv). 2007;49(3-4):5-12.
Rheumatoid arthritis and thyroid abnormalities.
Staykova ND.
Relationships between rheumatoid arthritis (RA) and the thyroid gland have been studied extensively for a long time. The studies of this problem have focused mainly on: (a) the functional and immune thyroid gland abnormalities in patients with previous history of RA, and (b) joint changes in patients with previous autoimmune thyroid diseases. Thyroid dysfunctions in RA patients are most often of autoimmune nature; they are accompanied by elevated thyroid autoantibody titers. The RA patients usually present with eu-, hypo- or hyperthyroid manifestations. The concurrent affection of joints and thyroid gland is related most probably to a genetic predisposition determined by the affiliation to a certain HLA type, most often HLA-DR. Joint abnormalities in thyroid gland disorders may be of different character (generally polyarthritis) and they are due to hypothyroidism. One possible explanation of the presence of two or more autoimmune diseases in one individual is microchimerism – the presence of a small number of fetal cells in the mother as well as maternal cells in the fetus. These data provide grounds for tests to be performed in all cases of RA so that thyroid autoantibodies and thyroid dysfunctions can be detected early and treated adequately.

Ann Rheum Dis. 2008 Feb;67(2):229-32. Epub 2007 Jun 8.
Rheumatoid arthritis is associated with a high prevalence of hypothyroidism that amplifies its cardiovascular risk.
Raterman HG, van Halm VP, Voskuyl AE, Simsek S, Dijkmans BA, Nurmohamed MT.
OBJECTIVE:
Rheumatoid arthritis (RA) patients have an increased risk of developing cardiovascular diseases (CVD). Other autoimmune diseases such as hypothyroidism are also associated with an enhanced risk for CVD. Our objective was to determine first, the prevalence of hypothyroid disorders in RA patients, and second, the risk of CVD in RA patients with hypothyroid abnormalities.
METHODS:
SUBJECTS:
were RA patients who participated in an ongoing prospective cohort study of cardiovascular mortality and morbidity (n = 358) in which hypothyroid abnormalities were assessed. CVD was defined as a verified medical history of coronary, cerebral or peripheral arterial disease.
RESULTS:
Clinical hypothyroidism was observed in 16 of 236 female RA patients (6.8%), which is significantly higher than in the general population of The Netherlands. Subclinical hypothyroidism was detected in 6 out of 236 RA women (2.5%). In female RA patients, CVD was present in 6 out of 16 (37.5%) of all hypothyroid women. The odds ratio for CVD comparing female hypothyroid RA patients with female euthyroid RA patients was 4.1 (95% CI 1.2-14.3) after adjustment for sex, age, diabetes, smoking (ever), hypertension and statin use.
CONCLUSIONS:
Clinical hypothyroidism was observed three times more often in female RA patients than females in the general population. In female RA patients, clinical hypothyroidism was associated with a fourfold higher risk of CVD in comparison with euthyroid female RA patients independently of the traditional risk factors.

Semin Arthritis Rheum. 1995 Feb;24(4):282-90.
Bone and joint manifestations of hypothyroidism.
McLean RM, Podell DN.
Hypothyroidism is frequently accompanied by musculoskeletal manifestations ranging from myalgias and arthralgias to true myopathy and arthritis. A case is presented in which an arthropathic process in the hip was the isolated finding in a young man who was severely hypothyroid. Previous literature on bone and joint manifestations of hypothyroidism is reviewed, with emphasis on cases where such manifestations were the presenting symptoms of thyroid dysfunction. Most cases of arthropathic changes in adult-recognized hypothyroidism involved the knees and hands, while the hip and the epiphysis of the femoral head appear more commonly involved in children. Thyroid hormones have known effects at the cellular level on proliferation and differentiation of bone and cartilage. The hypothyroid state appears to induce abnormalities in these tissues, which result in such clinical manifestations as epiphyseal dysgenesis, aseptic necrosis, possibly crystal-induced arthritis, and an arthropathy characterized by highly viscous noninflammatory joint effusions primarily affecting the knees, wrists, and hands. Neuropathic and myopathic symptoms accompanying hypothyroidism may manifest as joint region abnormalities when in fact there is no underlying arthropathy.

Postgrad Med J. 1985 Feb;61(712):157-9.
Hypothyroidism presenting as destructive arthropathy of the fingers.
Gerster JC, Quadri P, Saudan Y.
A patient presenting with destructive arthropathy of the proximal interphalangeal (PIP) joints of the hands is described. She was initially believed to have rheumatoid arthritis but non-steroidal anti-inflammatory drugs were of no help. The patient was subsequently found to have hypothyroidism and erosive osteoarthritis of the fingers. Joint swelling, pain and stiffness responded dramatically to thyroid hormone substitution. The PIP joint spaces reappeared on the radiographs within 9 months. This case suggest that hypothyroidism may induce destructive arthropathy of the finger joints. As thyroxine replacement may reverse the rheumatic complaints, hypothyroidism should be considered in the differential diagnosis of a destructive arthropathy of unclear aetiology.

Isr J Med Sci. 1987 Nov;23(11):1110-3.
Musculoskeletal symptoms as a presenting sign of long-standing hypothyroidism.
Krupsky M, Flatau E, Yarom R, Resnitzky P.
Muscle and joint pains and/or weakness are not usually stressed as central symptoms in hypothyroidism. Two cases of long-standing hypothyroidism presenting with prominent myopathic symptoms are described. The first patient presented with a 12-year history of proximal myopathy, arthropathy and skin abnormalities, and florid primary myxedema was diagnosed. No evidence for a systemic autoimmune process was found. The second patient had been treated with irradiation to the neck 23 years before admission and presented with clinical and laboratory signs of both proximal myopathy and hypothyroidism. Thyroid hormone replacement resulted in a complete recovery of all the musculoskeletal symptoms, with reversion to normal of the very high muscle enzyme levels in both patients. The cases presented illustrate that hypothyroidism can lead to the development of a variety of muscular, rheumatic and dermatologic syndromes easily confused with dermatomyositis or other collagen diseases.

J Pediatr. 1993 Oct;123(4):586-8.
Rheumatic symptoms associated with hypothyroidism in children.
Keenan GF, Ostrov BE, Goldsmith DP, Athreya BH.
We describe five children with varied rheumatic manifestations, including fibromyalgia and arthralgias, ultimately proved to be associated with hypothyroidism. All musculoskeletal symptoms improved after thyroid replacement therapy. We conclude that rheumatic manifestations of hypothyroidism can be as varied in children as in adults.

Muscle Nerve. 2002 Jul;26(1):141-4.
Hypothyroid myopathy with a strikingly elevated serum creatine kinase level.
Scott KR, Simmons Z, Boyer PJ.
Although serum creatine kinase (CK) levels are frequently modestly elevated in patients with hypothyroid myopathy, elevations in serum CK to the levels usually seen in inflammatory myopathies or dystrophies are rare. We report a patient with progressive proximal weakness and a serum CK level of over 29,000 IU/L, in whom subsequent laboratory evaluation identified profound hypothyroidism. Thyroid hormone replacement therapy resulted in resolution of clinical symptoms and a marked reduction in the serum CK level. Such a high serum CK level in a patient with hypothyroidism underscores the importance of assessing thyroid function in patients with weakness, regardless of serum CK levels, even when systemic symptoms and signs of hypothyroidism are minimal or absent.

Posted in General.

Tagged with , , , , , , .