Persons who develop one autoimmune disease are more likely to develop other autoimmune diseases. This is a commonly accepted fact which is discussed frequently amongst the members of our community. Research has demonstrated that persons diagnosed with rheumatoid arthritis are more likely to develop thyroid disorders such as hypothyroidism, or Hashimoto’s thyroiditis, and Grave’s disease, or hyperthyroidism.
Worldwide prevalence of rheumatoid arthritis and thyroid disease.
It has been documented that patients with RA experience an increased occurrence of thyroid disorders of both the autoimmune and non-autoimmune types. Did you know that joint pain can be a symptom of thyroid disease?
Common signs and symptoms of hypothyroidism (low thyroid) include dry skin, thinning hair, brittle nails, fatigue (feeling tired, sluggish, or weak), memory problems, depression, inability to tolerate cold, yellowish skin, and constipation. Less common symptoms may include modest weight gain, muscle aches and cramps, hoarseness, facial puffiness, and swelling in the limbs.
The worldwide prevalence of thyroid disease in patients with RA varies considerably, ranging from 0.5% in Morocco to 27% in Slovakia, according to a 2012 review of 17 published studies. The prevalence of thyroid disease in RA patients in North America ranges from 2.1% to 9.8%. Lack of universal agreement as to the ‘normal’ upper limit for TSH (thyroid stimulating hormone) levels in the blood may partially explain some of this variability as published upper limits range from 2.5 to 5.0 IU/mL.
In 2004, when I was first evaluated for possible RA, my SED rate was 31, RF was 5.3, and my TSH level was 3.2 IU/mL. None of these laboratory results prompted my primary care doctor to look any further into the cause(s) of the discomfort in my hands. It was two years later when my TSH tested at 5.1 IU/mL that my doctor started me on thyroid medication, only a few months before my RA was finally diagnosed. I’ve never truly experienced one disease without the other. One time when I ran out of thyroid medication for about 1-2 months, I did notice that I experienced more pain and depression before I got back on my meds.
RA + thyroid disease = Increased risk of cardiovascular disease.
Rheumatoid arthritis affects much more than just the joints. Patients with rheumatoid arthritis are at increased risk of developing cardiovascular disease. Did you know that hypothyroidism is also a risk factor for cardiovascular disease?
In a study of RA patients (n=358) in Amsterdam, clinical hypothyroidism was observed three times more often in female RA patients than females in the general population, 6.8% vs 2.7%, respectively. Researchers found that clinical hypothyroidism in female RA patients was associated with a fourfold higher risk of cardiovascular disease (CVD) compared to those with normal thyroid function. This increased risk was independent of traditional CVD risk factors.
In another study using data from 360,000 registered patients in the Netherlands Information Network of General Practice (LINH), prevalence of hypothyroidism was 6.5% in female arthritis patients compared to 3.9% in controls. The prevalence of cardiovascular disease was 4.3% in patients diagnosed with hypothyroidism, 5.9% in those with inflammatory arthritis, 14.3% in patients with a combination of both hypothyroidism and inflammatory arthritis, and 2.1% in controls. Adjusted CVD prevalence rates were 3.7 higher in patients with both hypothyroidism and inflammatory arthritis as compared with controls.
Reduce your risk.
Cardiovascular disease (CVD) is recognized as the leading cause of death in nearly 40% of patients with RA. It is important to reduce common risks of cardiovascular disease, such as high blood cholesterol levels, high blood pressure, diabetes, obesity, lack of exercise, cigarette smoking, etc. Patients may need to make lifestyle changes and take medication to reduce these risk factors.
Primary care doctors and rheumatologists should also be aware of the amplified cardiovascular risk in RA patients who develop thyroid disorders and advocate for better treatment of hypothyroidism in RA patients. Once you are diagnosed with thyroid disease, it is important to stay on therapy longterm and routinely be monitored so that treatment can be adjusted when necessary.
If you have questions about thyroid disease, cardiovascular risk, and rheumatoid arthritis, please ask your doctor about being tested. It is possible that what may be acceptable or "normal’ for a healthy person requires more aggressive treatment in a patient with RA.
Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine. 2004 Jun;24(1):1-13.
CÃ¡rdenas RoldÃ¡n J1, Amaya-Amaya J, Castellanos-de la Hoz J, et al. Autoimmune thyroid disease in rheumatoid arthritis: a global perspective. Arthritis. 2012;2012:864907. doi: 10.1155/2012/864907. Epub 2012 Nov 18.
Dhawan SS, Quyyumi AA. Rheumatoid arthritis and cardiovascular disease. Curr Atheroscler Rep. 2008 Apr;10(2):128-33.
Raterman HG, Nielen MM, Peters MJ, et al. Coexistence of hypothyroidism with inflammatory arthritis is associated with cardiovascular disease in women. Ann Rheum Dis. 2012 Jul;71(7):1216-8. doi: 10.1136/annrheumdis-2011-200836. Epub 2012 Mar 14.
Raterman HG, van Halm VP, Voskyul AE, et al. Rheumatoid arthritis is associated with a high prevalence of hypothyroidism that amplifies its cardiovascular risk. Ann Rheum Dis. 2008 Feb;67(2):229-32. Epub 2007 Jun 8.
Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.