Enfermedad tiroidea autoinmune en pacientes colombianos con lupus eritematoso sistémico
Franco Aristizabal, Juan Sebastian
Objective: To determine the prevalence and the associated factors of autoimmune hypothyroidism (AH) within a systemic lupus erythematosus (SLE) cohort, and to analyze the current information concerning the prevalence and impact of autoimmune thyroid disease (AITD) and thyroid autoimmunity in patients with SLE. Methods: This was a two/step study. First, a total of 376 patients with SLE were assessed for the presence of the following: 1) confirmed AH, 2) positive thyroperoxidase antibodies/thyroglobulin antibodies [TPOAb/TgAb] without hypothyroidism, 3) non-autoimmune hypothyroidism and 4) SLE patients with neither. Multivariate analysis and a classification and regression tree model were used to analyze data. Second, the current information was evaluated through a systematic literature review (SLR). The PRISMA guidelines were followed to search in PubMed, Scopus, SciELO and Virtual Health Library databases. Results: In our cohort, the prevalence of confirmed AH was 12% (Group 1). However, the TPOAb and TgAb-positive frequencies were 21% and 10%, respectively (Group 2). SLE patients with neither comprised 40% of the cohort. Patients with confirmed AH were significantly older and had later age at onset of the disease. Smoking (AOR 6.93, 95% CI 1.98-28.54, p= 0.004), Sjögren’s Syndrome (SS) (AOR 23.2, 95% CI 1.89-359.53, p= 0.015) and positivity for anti-cyclic citrullinated peptide (anti-CCP) (AOR 10.35, 95% CI 1.04-121.26, p= 0.047) were associated with AH-SLE, regardless of gender and duration of the disease. Smoking and SS were confirmed as predictors of AH-SLE. In the SLR, the prevalence of AITD ranged from 1% to 60%. The factors associated with this polyautoimmunity were female gender, older age, smoking, certain autoantibodies, SS, and, cutaneous and articular involvement. Conclusions: AITD is frequent in SLE, and it does not affect the severity of SLE. Identified risk factors will assist clinicians in the search for AITD. Our results encourage smoke-free policies in patients with SLE.