AB0349 ENDOCRINE DYSFUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS AND THEIR RELATIONSHIP TO DISEASE SEVERITY

Abstract

Background Rheumatoid arthritis (RA) is known to be associated with multiple endocrine dysfunctions including hypothyroidism, adrenal insufficiency, hyperprolactinemia, and hypoandrogenism. The link between endocrine system and synovitis in RA is attributed to the presence of functional receptors for glucocorticoids, androgens and estrogen in the synoviocytes which function as an intracrine system [1,2]. Objectives To describe endocrine dysfunction in patients with RA and to determine its relationship with disease severity and disease duration. Methods We studied RA patients diagnosed using ACR/EULAR 2010 at our clinic in Jodhpur, India from January 2021 to August 2021 after written informed consent and Ethical Committee approval. We collected the clinical, demographic, treatment history and calculated disease severity with Disease Activity Score (DAS28) and Simplified Disease Activity Index (SDAI). Serum samples for thyroid profile, prolactin, dehydroepiandrosterone sulphate (DHEAS), testosterone, cortisol, Tumor Necrosis Factor alpha (TNF-ɑ) and Interleukin 6 (IL-6) were collected and stored at -80C and analysed by chemiluminescent immunoassay (Siemens Advia Centaur© immunoassay system, USA) as per the standard hospital protocol. Spearman’s correlation was used to determine the relationship between endocrine dysfunction with disease severity scores and total disease duration. Results Among the 160 patients included in the study, 4 were on levothyroxine supplementation for hypothyroidism. Thirteen patients (8.8%) had primary hypothyroidism, 2 patients (1.3%) had subclinical hypothyroidism with no cases of central hypothyroidism and 31 patients (20.9%) had sick euthyroid syndrome (Table 1). Hyperprolactinemia was seen in 24.3% patients and the mean level of serum prolactin increased as the disease severity increased but it was not statistically significant (Figure 1). DHEAS levels were below the accepted age and gender cut-offs in 56.4% patients while 56.6% had low testosterone. Among the 99 patients who had random cortisol values, 36 patients (36.4%) had adrenal insufficiency (random cortisol range<3 µg/dl). Serum cortisol was negatively correlated with serum TNF-ɑ but had no relationship with serum IL-6. None of the endocrine parameters were correlated with disease severity scores (SDAI/DAS) or their individual components. Conclusion Considerable percentage of patients with RA have endocrine dysfunction compared to the general population, likely secondary to raised inflammatory cytokines produced at synovial tissues. However, they do not correlate to disease activity or disease duration in RA. References [1] Cutolo M, Straub RH, Bijlsma JWJ. Neuroendocrine-immune interactions in synovitis. Nat Clin Pract Rheumatol. 2007 Nov;3(11):627–34. [2] Filippa MG, Tektonidou MG, Mantzou A, Kaltsas GA, Chrousos GP, Sfikakis PP, et al. Adrenocortical dysfunction in rheumatoid arthritis: Α narrative review and future directions. Eur J Clin Invest. 2022 Jan;52(1):e13635. View this table: Table 1. Endocrine dysfunction in patients with Rheumatoid arthritis. ![Figure][1] Acknowledgements: NIL. Disclosure of Interests None Declared. [1]: pending:yes