抗リウマチ薬が甲状腺疾患を予防する可能性(Anti-rheumatic drugs could prevent thyroid disease)

2023-11-23

2023-11-22 カロリンスカ研究所(KI)

◆関節リウマチ(RA)患者は自己免疫性甲状腺疾患の発症リスクが高いが、これまでその関連については十分に解明されていなかった。
◆スウェーデンの研究では、RA治療に使われる免疫調節薬が自己免疫性甲状腺疾患の発症リスクを46%低減させる可能性があることが明らかになった。これにより、免疫調節薬が自己免疫性甲状腺疾患の予防に寄与する可能性が示唆され、今後の臨床試験でその有用性が検証される可能性が高まった。

<関連情報>

関節リウマチ患者における疾患修飾性抗リウマチ薬とサイロキシン治療による自己免疫性甲状腺疾患のリスク Disease-modifying antirheumatic drugs and risk of thyroxine-treated autoimmune thyroid disease in patients with rheumatoid arthritis

Kristin Waldenlind, Bénédicte Delcoigne, Saedis Saevarsdottir, Johan Askling
Journal of Internal Medicine Published: 22 November 2023
DOIhttps://doi.org/10.1111/joim.13743

Abstract

Background
Autoimmune thyroid disease (AITD) and rheumatoid arthritis (RA) share a genetic background, and the prevalence of AITD in RA patients is increased. Whereas immunomodulatory treatments are used in RA, they are rarely used in AITD.

Objectives
We hypothesized that disease-modifying antirheumatic drugs (DMARDs) as used in RA might lower the risk of incident AITD.

Methods
A nationwide cohort study including 13,731 patients with new-onset RA from the Swedish Rheumatology Quality Register 2006–2018 and 63,201 matched general population comparators linked to national registers to identify AITD. We estimated relative risks (hazard ratios) of AITD after RA diagnosis in RA patients compared to the general population, and in relation to DMARD treatment, using Cox regression.

Results
Following RA diagnosis, 321 (2.3%) of the RA patients and 1838 (2.9%) of the population comparators developed AITD, corresponding to an incidence of 3.7 versus 4.6 per 1000 person-years, hazard ratio, 0.81; 95% CI, 0.72–0.91. The decreased risk of incident AITD among RA patients compared to the general population was most pronounced among biologic DMARD (bDMARD) treated patients, with a hazard ratio of 0.54; 95% CI, 0.39–0.76. Among RA patients, subgrouped by bDMARD use, TNF-inhibitors were associated with the most pronounced decrease, hazard ratio, 0.67; 95% CI, 0.47–0.96.

Conclusions
In contrast to the increased prevalence of AITD in RA patients at diagnosis, our results indicate that the risk of AITD decreases following RA diagnosis. This decrease is especially pronounced in RA patients treated with bDMARDs. These findings support the hypothesis that DMARDs might have a preventive effect on AITD.