Anti-rheumatic drugs could prevent thyroid disease

Anti-rheumatic drugs could help to prevent the development of autoimmune thyroid disease, an observational study suggests.

Patients with rheumatoid arthritis are at increased risk of autoimmune thyroid diseases, such as Hashimoto’s disease and Graves’ disease and they are usually treated with immunomodulatory drugs that affect the immune system and are given thyroid hormone to compensate for the changes in normal thyroid function that accompany autoimmune thyroid disease, the Swedish researchers say.

Researchers from Karolinska Institutet, Sweden, publishing in the Journal of Internal Medicine, investigated whether the immunomodulatory drugs that reduce inflammation in the joints of RA patients might also reduce the risk of these patients developing autoimmune thyroid disease.

Previous studies in mice suggest that DMARDs, a type of immune-modulatory drugs used to treat rheumatoid arthritis, can reduce inflammation in the thyroid gland.

They used data between 2006 and 2018 on more than 13,000 RA patients and their treatment, as well as data from more than 63,000 individuals in a matched control group without rheumatoid arthritis.

The risk of developing an autoimmune thyroid disease among RA patients was lower after their onset of the rheumatic disease than before diagnosis, with the most pronounced reduction in the risk of autoimmune thyroid disease being seen in patients with rheumatoid arthritis treated with immunomodulatory drugs (biological DMARDs). In these patients, the risk of autoimmune thyroid disease was 46% lower than in the control group without rheumatoid arthritis.

First study author Kristin Waldenlind, researcher at the Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, said: “These results support the hypothesis that certain types of immunomodulatory drugs could have a preventive effect on autoimmune thyroid disease.

“Our results do not prove that it is the treatment with immunomodulatory drugs that led to the reduced risk of autoimmune thyroid disease but provide support for this hypothesis.

“The results, if they can be replicated in further studies, open up the possibility of studying more directly in clinical trials whether the immunomodulatory drugs currently used for rheumatoid arthritis could also be used for the early treatment of autoimmune thyroid disease, i.e. for new areas of use of these drugs, known as drug repurposing.”

Waldenlind K, Delcoigne B, Saevarsdottir S et al. Disease-modifying antirheumatic drugs and risk of thyroxine-treated autoimmune thyroid disease in patients with rheumatoid arthritis. Journal of Internal Medicine 22 November 2023; doi: 10.1111/joim.13743


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