Top

20-11-2023 | Juvenile Rheumatoid Arthritis | Original Article

Thyroid function in pediatric patients with juvenile idiopathic arthritis

Authors: Mariella Valenzise, Federica D’Amico, Eleonora Tripodi, Giuseppina Zirilli, Angela Alibrandi, Romina Gallizzi, Diana Sutera, Giulia Cafarella, Cecilia Lugarà, Malgorzata Gabriela Wasniewska

Published in: Endocrine

Abstract

Purpose

Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease characterized by chronic synovitis, sometimes associated with fever, rash, pericarditis and uveitis. Limited data are available concerning autoimmune diseases associated with JIA in childhood. The aims of our study were: (a) evaluating the thyroid function in a group of Italian children affected by JIA; (b) identifying which Autoimmune Thyroid Diseases (ATDs) are related to JIA in this population.

Methods

A population of 51 patients with JIA was investigated. Each patient enrolled was evaluated clinically (family history for Autoimmune Diseases (ADs), personal history and physical examination). In the sample were evaluated thyroid function, inflammation’s index and anti-thyroid antibodies.

Results

The 68.6% (35) of our patients had the oligoarticular form, 27.5% (14) had the polyarticular one, 2% (1) had systemic onset and 2% (1) had undifferentiated arthritis. We focused our attention on the differences between the first two forms. We did not find any difference on the gender prevalence (p > 0.05). A higher presence of anti-TPO antibodies was found in the polyarticular form, with a significant difference with the oligoarticular one (p = 0.032). We researched the anti-hTG antibodies (p > 0.05) and ANA for each group (p > 0.05). We found a significant prevalence of family history for ADs in the polyarticular form (p < 0.05).

Conclusion

Our findings show the necessity to focus on thyroid function in patients with JIA. Although the oligoarticular form is the most frequent, the polyarticular form shows a higher frequency of thyroid function’s alteration. This suggests the need for specific attention in polyarticular form.

A. Ravelli, A. Martini, Juvenile idiopathic arthritis. Lancet 369(9563), 767–778 (2007). https://doi.org/10.1016/S0140-6736(07)60363-8 CrossRefPubMed

M. Seid, L. Opipari, B. Huang et al. Disease control and health-related quality of life in juvenile idiopathic arthritis. Arthritis Rheum 61(3), 393–399 (2009). https://doi.org/10.1002/art.24477 CrossRefPubMedPubMedCentral

S. Ringold, S.T. Angeles-Han, T. Beukelman et al. 2019 American college of rheumatology/arthritis foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Care Res (Hoboken) 71(6), 717–734 (2019). https://doi.org/10.1002/acr.23870 CrossRefPubMed

R.E. Petty, T.R. Southwood, P. Manners et al. International league of associations for rheumatology. international league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2), 390–392 (2004) PubMed

S. Prahalad, M.H. Ryan, E.S. Shear et al. Twins concordant for juvenile rheumatoid arthritis. Arthritis Rheum 43(11), 2611–2612 (2000). 10.1002/1529-0131(200011)43:11<2611::AID-ANR33>3.0.CO;2-T CrossRefPubMed

B. Andersson Gäre, Juvenile arthritis—who gets it, where and when? A review of current data on incidence and prevalence. Clin Exp Rheumatol 17(3), 367–374 (1999) PubMed

L.R. Wedderburn, N. Robinson, A. Patel et al. Selective recruitment of polarized T cells expressing CCR5 and CXCR3 to the inflamed joints of children with juvenile idiopathic arthritis. Arthritis Rheum 43(4), 765–774 (2000). https://doi.org/10.1002/1529-0131(200004)43:4<765::AID-ANR7>3.0.CO;2-B CrossRefPubMed

S. Stagi, T. Giani, G. Simonini et al. Thyroid function, autoimmune thyroiditis and coeliac disease in juvenile idiopathic arthritis. Rheumatology (Oxford) 44(4), 517–520 (2005). https://doi.org/10.1093/rheumatology/keh531 CrossRefPubMed

A.P. Andonopoulos, V. Siambi, M. Makri et al. Thyroid function and immune profile in rheumatoid arthritis. A controlled study. Clin Rheumatol 15(6), 599–603 (1996). https://doi.org/10.1007/BF02238551 CrossRefPubMed

10.

D.J. Walker, M. Griffiths, I.D. Griffiths, Occurrence of autoimmune diseases and autoantibodies in multicase rheumatoid arthritis families. Ann Rheum Dis 45(4), 323–326 (1986). https://doi.org/10.1136/ard.45.4.323 CrossRefPubMedPubMedCentral

11.

D. Alhomaidah, A. Alsagheir, S.M. Al-Mayouf, Coexistence of endocrinopathies in children with rheumatic diseases. Int J Pediatr Adolesc Med 3(3), 119–122 (2016). https://doi.org/10.1016/j.ijpam.2016.04.002 CrossRefPubMedPubMedCentral

12.

S.M. Al-Mayouf, A. Alrasheedi, I. Almsellati et al. Familial aggregation of juvenile idiopathic arthritis with other autoimmune diseases: Impact on clinical characteristics, disease activity status and disease damage. Int J Rheum Dis 24(8), 1080–1085 (2021). https://doi.org/10.1111/1756-185X.14167 CrossRefPubMed

13.

M.G. Alpigiani, M. Cerboni, I. Bertini et al. Endocrine autoimmunity in young patients with juvenile chronic arthritis. Clin Exp Rheumatol 20(4), 565–568 (2002) PubMed

14.

J.W. van Straalen, S. de Roock, G. Giancane et al. Paediatric rheumatology international trials organisation (PRINTO). Prevalence of familial autoimmune diseases in juvenile idiopathic arthritis: results from the international Pharmachild registry. Pediatr Rheumatol Online J 20(1), 103 (2022). https://doi.org/10.1186/s12969-022-00762-y CrossRefPubMedPubMedCentral

15.

C.M. Dayan, G.H. Daniels, Chronic autoimmune thyroiditis. N Engl J Med 335(2), 99–107 (1996). https://doi.org/10.1056/NEJM199607113350206. Jul CrossRefPubMed

16.

M. Valenzise, T. Aversa, A. Saccomanno et al. Epidemiological and clinical peculiarities of polyglandular syndrome type 3 in pediatric age. Ital J Pediatr 43(1), 69 (2017). https://doi.org/10.1186/s13052-017-0386-4 CrossRefPubMedPubMedCentral

17.

L. Iughetti, L. Lucaccioni, F. Fugetto et al. Thyroid function in Down syndrome. Expert Rev Endocrinol Metab 10(5), 525–532 (2015). https://doi.org/10.1586/17446651.2015.1063995 CrossRefPubMed

18.

T. Aversa, M. Valenzise, A. Corrias et al. In children with autoimmune thyroid diseases the association with Down syndrome can modify the clustering of extra-thyroidal autoimmune disorders. J Pediatr Endocrinol Metab 29(9), 1041–1046 (2016). https://doi.org/10.1515/jpem-2016-0073 CrossRefPubMed

19.

E.M. Kyritsi, C. Kanaka-Gantenbein, Autoimmune thyroid disease in specific genetic syndromes in childhood and adolescence. Front Endocrinol (Lausanne) 11, 543 (2020). https://doi.org/10.3389/fendo.2020.00543 CrossRefPubMed

20.

R.S. Brown, Autoimmune thyroiditis in childhood. J Clin Res Pediatr Endocrinol 5, 45–49 (2013). https://doi.org/10.4274/jcrpe.855. CrossRefPubMedPubMedCentral

21.

C. Bray, L.N. Bell, H. Liang et al. Erythrocyte sedimentation rate and c-reactive protein measurements and their relevance in clinical medicine. WMJ. 115(6), 317–321 (2016) PubMed

22.

A. Ravelli, G.C. Varnier, S. Oliveira et al. Antinuclear antibody-positive patients should be grouped as a separate category in the classification of juvenile idiopathic arthritis. Arthritis Rheum 63(1), 267–275 (2011). https://doi.org/10.1002/art.30076 CrossRefPubMed

23.

D. Holzinger, D. Föll, Biomarker für chronisch-entzündliche Erkrankungen [Biomarkers for chronic inflammatory diseases]. Z Rheumatol 74(10), 887–896 (2015). https://doi.org/10.1007/s00393-015-0009-7. CrossRefPubMed

24.

O. Kordonouri, A. Klinghammer, E.B. Lang et al. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care 25(8), 1346–1350 (2002). https://doi.org/10.2337/diacare.25.8.1346 CrossRefPubMed

25.

Y. Tomer, F. Menconi, Type 1 diabetes and autoimmune thyroiditis: the genetic connection. Thyroid 19(2), 99–102 (2009). https://doi.org/10.1089/thy.2008.1565 CrossRefPubMed

26.

C.E. Tagoe, A. Zezon, S. Khattri, Rheumatic manifestations of autoimmune thyroid disease: the other autoimmune disease. J Rheumatol 39(6), 1125–1129 (2012). https://doi.org/10.3899/jrheum.120022. CrossRefPubMed

27.

R.M. Ruggeri, F. Trimarchi, G. Giuffrida et al. Autoimmune comorbidities in Hashimoto’s thyroiditis: different patterns of association in adulthood and childhood/adolescence. Eur J Endocrinol 176(2), 133–141 (2017). https://doi.org/10.1530/EJE-16-0737 CrossRefPubMed

28.

T. Aversa, D. Corica, G. Zirilli et al. Phenotypic expression of autoimmunity in children with autoimmune thyroid disorders. Front Endocrinol (Lausanne) 10, 476 (2019). https://doi.org/10.3389/fendo.2019.00476 CrossRefPubMedPubMedCentral

29.

E. Tronconi, A. Miniaci, A. Pession, The autoimmune burden in juvenile idiopathic arthritis. Ital J Pediatr 43(1), 56 (2017). https://doi.org/10.1186/s13052-017-0373-9 CrossRefPubMedPubMedCentral

30.

L. Harel, D. Prais, Y. Uziel et al. Increased prevalence of antithyroid antibodies and subclinical hypothyroidism in children with juvenile idiopathic arthritis. J Rheumatol 33(1), 164–166 (2006) PubMed

31.

E. Unsal, O. Oren, K. Salar et al. The frequency of autoimmune thyroid disorders in juvenile idiopathic arthritis. Turk J Pediatr 50(5), 462–465 (2008) PubMed

32.

S.T. Ngo, F.J. Steyn, P.A. McCombe, Gender differences in autoimmune disease. Front Neuroendocrinol 35(3), 347–369 (2014). https://doi.org/10.1016/j.yfrne.2014.04.004 CrossRefPubMed

33.

K. Barut, A. Adrovic, S. Şahin et al. Juvenile idiopathic arthritis. Balkan Med J 34(2), 90–101 (2017). https://doi.org/10.4274/balkanmedj.2017.0111 CrossRefPubMedPubMedCentral

34.

A.M. Kucharska, E. Witkowska-Sȩdek, D. Labochka et al. Clinical and biochemical characteristics of severe hypothyroidism due to autoimmune thyroiditis in children. Front Endocrinol (Lausanne) 11, 364 (2020). https://doi.org/10.3389/fendo.2020.00364 CrossRefPubMed

35.

S.S. McCoy, C.S. Crowson, S.E. Gabriel et al. Hypothyroidism as a risk factor for development of cardiovascular disease in patients with rheumatoid arthritis. J Rheumatol 39(5), 954–958 (2012). https://doi.org/10.3899/jrheum.111076 CrossRefPubMedPubMedCentral

36.

S. Taddei, N. Caraccio, A. Virdis et al. Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism: beneficial effect of levothyroxine therapy. J Clin Endocrinol Metab 88(8), 3731–3737 (2003). https://doi.org/10.1210/jc.2003-030039 CrossRefPubMed

37.

S. Taddei, N. Caraccio, A. Virdis et al. Low-grade systemic inflammation causes endothelial dysfunction in patients with Hashimoto’s thyroiditis. J Clin Endocrinol Metab 91(12), 5076–5082 (2006). https://doi.org/10.1210/jc.2006-1075 CrossRefPubMed

38.

T.C. Robazzi, L.F. Adan, K. Pimentel et al. Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever. Clin Exp Rheumatol 31(2), 310–317 (2013) PubMed

Title: Thyroid function in pediatric patients with juvenile idiopathic arthritis
Authors: Mariella Valenzise
Federica D’Amico
Eleonora Tripodi
Giuseppina Zirilli
Angela Alibrandi
Romina Gallizzi
Diana Sutera
Giulia Cafarella
Cecilia Lugarà
Malgorzata Gabriela Wasniewska
Publication date: 20-11-2023
Publisher: Springer US
Keywords: Juvenile Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis
Arthritis
Celiac Disease
Celiac Disease
Thyroiditis
Published in: Endocrine
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-023-03600-7

Webinar | 08-11-2023 | 18:00 (CET)

Keynote Webinar | Spotlight on Diet and Diabetes

Watch now

An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. Highlights include discussion of the recent EASD guidelines, therapeutic diets, food types and processing, plus psychological factors that influence patient success, and the drivers of healthy eating and diabetes control.

Prof. Mike Lean

Prof. Falko Sniehotta

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Keynote Webinar | Spotlight on Diet and Diabetes