Thyroid Disease and Arthritis: The Link

Patient Expert

Thyroid disease can cause pain in your joints. You may not realize, however, that there is also a link between your thyroid and the various inflammatory joint diseases that fall into the category of arthritis. Thyroid disease is in fact linked to psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis. In this article, you will learn about the relationship between thyroid disease and arthritis as well symptoms, diagnosis, and treatments.

Psoriatic arthritis

Psoriatic arthritis is an autoimmune condition in which your immune system attacks joint and skin cells and causes joint inflammation, and over time, can also trigger joint damage. Psoriatic arthritis is diagnosed in around 30 percent of people with psoriasis. The disease frequently includes flare-ups, followed by periods of remission.

There is an increased risk of hypothyroidism, elevated thyroid peroxidase (TPO) antibodies (evidence of Hashimoto’s disease), in people with psoriatic arthritis. Some experts recommend testing periodic TPO antibodies and thyroid function — along with a thyroid ultrasound — in all patients with psoriatic arthritis.

Symptoms of psoriatic arthritis include:

  • Psoriasis of the skin, including red patches, lesions, and silvery scales, along with
  • Pain, stiffness, swelling, and warmth in one or many joints

Specifically, fingers and toes can become swollen or disfigured. Achilles tendinitis and plantar fasciitis in the feet are also common. It’s also common to develop lower back pain.

Diagnosis of psoriatic arthritis involves:

  • An examination of your joints and feet for any signs of pain or swelling
  • X-rays or magnetic resonance imaging (MRI) in some cases, to pinpoint joint swelling and changes

Your doctor may also do other tests to differentiate psoriatic arthritis from other conditions, for example:

• A blood test for rheumatoid factor (RF), which is a marker for rheumatoid arthritis, to distinguish between the two conditions • A biopsy of the joint fluid, to determine if it contains uric acid crystals, a marker for gout

There is no cure for psoriatic arthritis. The treatment emphasizes control of joint inflammation to minimize pain and prevent damage to your joints.

The treatments for psoriatic arthritis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — ibuprofen and naproxen sodium, and in some cases, prescription drugs — to relieve pain
  • Steroid injections to reduce inflammation
  • Disease-modifying antirheumatic drugs (DMARDs) — methotrexate, leflunomide, and sulfasalazine
  • Immunosuppressants, such as azathioprine and cyclosporine
  • Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia)
  • Psoriasis medications such as apremilast (Otezla), ustekinumab (Stelara) and secukinumab (Cosentyx)
  • Joint replacement surgery, for severely damaged joints

Ankylosing spondylitis

Ankylosing spondylitis is an inflammatory condition in the spine that causes vertebrae to fuse together.

Research has shown that the rate of autoimmune thyroid disease, specifically Hashimoto’s thyroiditis, is significantly higher in ankylosing spondylitis patients, compared to a healthy control group. Because of the higher prevalence of thyroid disease, experts recommend that patients with ankylosing spondylitis be evaluated for evidence of autoimmune thyroid dysfunction. Because of the link, Hashimoto’s patients should also be aware of the symptoms of ankylosing spondylitis, as early diagnosis and treatment can slow or prevent the progression of the condition.

The symptoms of ankylosing spondylitis include:

  • Loss of spine flexibility
  • A hunched posture
  • Rib pain, sometimes causing difficulty breathing
  • Inflammation in the eyes
  • Pain and stiffness in the lower back and hips
  • Neck pain
  • Fatigue
  • Pain in the back of the heel, breastbone, ribs, hips, or shoulder joints

There is no specific cause of ankylosing spondylitis, but there are autoimmune and/or genetic triggers identified in some people.

Over time, ankylosing spondylitis can be associated with uveitis, an inflammation of the eyes, compression fractures of the vertebra, and inflammation of the aorta.

Ankylosing spondylitis is diagnosed by visual examination of your range of motion, and in some cases, X-rays, and MRI to get a clear picture of any changes in joints and bones.

The treatment for ankylosing spondylitis focuses on relieving pain and stiffness and preventing damage to the spine and joints. Treatments include:

  • Physical therapy and exercises
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — ibuprofen and naproxen sodium, and in some cases, prescription drugs — to relieve pain.
  • Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia)
  • An IL-17 inhibitor, such as secukinumab (Cosentyx)
  • Joint replacement surgery, for severely damaged joints

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune inflammatory disease that can affect your joints, eyes, skin, blood vessels, and organs like the lungs and heart. The Arthritis Foundation estimates that 1.5 million Americans are affected by rheumatoid arthritis (RA)

When it attacks a joint, rheumatoid arthritis affects the joint's lining, causing swelling, pain, and in some cases, erosion of bones and damage to the joint. As an autoimmune disease, having rheumatoid arthritis puts you at higher risk of other autoimmune diseases, such as Hashimoto’s thyroiditis and Graves’ disease. Similarly, having autoimmune thyroid disease puts you at a higher risk of having another autoimmune condition, including rheumatoid arthritis.

One study found that nearly 10 percent of rheumatoid arthritis patients had autoimmune thyroid disease, and almost 38 percent had thyroid peroxidase (TPO) antibodies, consistent with Hashimoto's thyroiditis. Some experts recommend that given the higher prevalence of Hashimoto’s thyroiditis in rheumatoid arthritis patients, they should be routinely tested for thyroid antibodies and thyroid function to ensure early detection and treatment of thyroid disease.

The signs and symptoms of rheumatoid arthritis can include:

  • Tenderness and pain in joints
  • Swelling and warmth in joints
  • Joint stiffness, especially in the morning, or after a period of inactivity
  • Fatigue
  • Fever
  • Weight loss

The pain and symptoms can range from mild to severe, and you may experience flare-ups followed by periods of remission. Over time, rheumatoid arthritis can permanently change and deform joints.

Rheumatoid arthritis is typically diagnosed by a rheumatologist, using the following criteria:

  • Your reported symptoms
  • Visual evidence of swelling, redness, and warmth in your joints
  • Blood test results, including elevated erythrocyte sedimentation rate and/or C-reactive protein (CRP), and evidence of rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies
  • X-rays to evaluate any potential joint damage

Treatments for rheumatoid arthritis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen and naproxen sodium, and in some cases, prescription drugs — to relieve pain.
  • Oral steroids such as prednisone, to reduce acute inflammation
  • Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). These drugs can help slow the progression and help prevent permanent damage to joints and tissues.
  • Biologic response modifiers, to calm immune-related inflammation. These drugs include etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), adalimumab (Humira), and tofacitinib (Xeljanz), among others.
  • Physical and occupational therapy, to help maintain flexibility, and accommodate the joint-related disability
  • Surgery, to repair tendons, to remove inflamed joint linings, to fuse and stabilize joints, or repair damaged joints

Some integrative physicians have had success treating rheumatoid arthritis patients with low dose naltrexone (LDN).

Your next steps?

Since thyroid disease can cause generalized joint pain — but also is associated with various forms of arthritis — if you are being treated for thyroid disease, it is essential to consult an expert for evaluation of joint pain symptoms. An examination, blood tests, and imaging tests can help rule out or diagnose psoriatic arthritis, ankylosing spondylitis, or rheumatoid arthritis. Early diagnosis and treatment of these forms of arthritis can help prevent long-term disability and permanent damage to your joints.