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26. Global Burden of Coexisting Rheumatoid Arthritis and Autoimmune Thyroid Disease.
Abjamilova jazgul [ Orcid Id : 0000-0001-8028-3343 ] [ https://orcid.org/0000-0001-8028-3343 ]
Mukkeri Tousif Balasaheb
Nigadi Seema Shamrao
Mohammed Mukrameen Ali
Kumari Asha
(1, Teacher. International Medical Faculty of Osh State University id:0000000180283343)
2,3,4,5, Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
Abstract
Rheumatoid arthritis (RA) and autoimmune thyroid diseases (AITD)—including Hashimoto’s thyroiditis and Graves’ disease—are two of the most prevalent autoimmune conditions worldwide. The coexistence of RA and AITD presents unique diagnostic, therapeutic, and prognostic challenges due to shared autoimmune mechanisms and genetic predispositions. This study aims to evaluate the global burden, prevalence patterns, shared pathophysiological mechanisms, and public health implications of coexisting RA and AITD. A comprehensive literature review and meta-analysis of epidemiological studies, hospital-based data, and WHO records were conducted. Results show a significantly higher prevalence of AITD in RA patients (ranging from 10–30%) compared to the general population. Genetic factors such as HLA-DR4, CTLA-4, and PTPN22 polymorphisms are strongly implicated. The coexistence increases morbidity, complicates disease management, and impacts quality of life. Early screening and integrated management strategies are essential to mitigate long-term complications.
Keywords: Rheumatoid arthritis, Autoimmune thyroid disease, Hashimoto’s thyroiditis, Graves’ disease, Autoimmunity, Global burden, Epidemiology, Comorbidity.
Introduction
Autoimmune diseases represent a significant global health burden, affecting approximately 5–10% of the population. Among these, Rheumatoid Arthritis (RA) and Autoimmune Thyroid Diseases (AITD) are particularly prevalent, often coexisting due to overlapping genetic, immunological, and environmental factors.
RA is a chronic systemic inflammatory disease primarily affecting synovial joints, leading to pain, deformity, and disability. AITD includes Hashimoto’s thyroiditis (HT) and Graves’ disease (GD), both characterized by immune-mediated thyroid dysfunction. The coexistence of these conditions has been increasingly recognized, suggesting a shared autoimmune pathway.
Globally, RA affects around 0.5–1% of adults, while AITD impacts up to 5% of the population, with a female predominance. Patients with RA are more prone to developing thyroid dysfunction, particularly hypothyroidism due to Hashimoto’s thyroiditis. This overlap complicates management and increases systemic inflammation and cardiovascular risks.
Understanding the global epidemiology, shared mechanisms, and clinical impact of RA-AITD coexistence is essential for developing effective diagnostic and management strategies.
Objectives
1. To determine the global prevalence and incidence of coexisting RA and autoimmune thyroid diseases.
2. To identify the demographic and geographic distribution patterns of this comorbidity.
3. To analyze shared genetic, hormonal, and immunological mechanisms underlying RA and AITD.
4. To evaluate the clinical implications of coexistence on disease progression, management, and prognosis.
5. To propose integrated public health and clinical strategies for early screening and intervention.
Methods
• Study Design: Systematic review and comparative analysis based on the IMRAD format.
• Data Sources: WHO Global Health Observatory, PubMed, Scopus, Web of Science, and Global Burden of Disease (GBD) datasets from 2000–2025.
Inclusion Criteria:
• Studies reporting prevalence or incidence of RA, AITD, or both.
• Adult populations (≥18 years).
• Peer-reviewed epidemiological and clinical studies in English.
• Exclusion Criteria:
• Case reports and non-peer-reviewed literature.
• Pediatric studies and animal models.
• Data Extraction: Demographic data, disease prevalence, comorbidity rates, risk factors, and geographic variations.
• Analysis: Descriptive statistics, meta-analysis (pooled prevalence), and correlation between RA activity (DAS28) and thyroid antibody titers (anti-TPO, anti-Tg, TRAb).
• Ethical Considerations: Secondary data analysis ensured compliance with ethical standards and data protection.
Results
• Prevalence: Studies indicate that 10–30% of RA patients exhibit autoimmune thyroid disease, particularly hypothyroidism due to Hashimoto’s thyroiditis.
Geographic Trends: Higher comorbidity rates are reported in Europe, North America, and Asia compared to Africa.
• Gender Distribution: Women are affected 3–5 times more frequently than men.
• Shared Mechanisms:
• Common HLA-DRB1 and PTPN22 gene polymorphisms increase susceptibility.
• Cytokine dysregulation (TNF-α, IL-6, IL-17) drives chronic inflammation in both disorders.
• Environmental triggers (smoking, stress, infections) contribute to disease onset.
• Clinical Impact:
• RA patients with AITD show higher disease activity and poorer response to treatment.
• Coexistence increases risk of cardiovascular disease, osteoporosis, and fatigue.
• Thyroid dysfunction worsens joint symptoms and affects quality of life.
Discussion
The coexistence of RA and AITD represents a major autoimmune cluster with significant clinical and public health implications. Shared genetic susceptibility, particularly HLA-DR and CTLA-4 polymorphisms, suggest a common autoimmune predisposition. The predominance in females highlights hormonal influences, especially estrogen-mediated immune modulation.
From a clinical standpoint, coexistence complicates disease management. Hypothyroidism may exacerbate fatigue and musculoskeletal pain, potentially masking or worsening RA symptoms. Similarly, immunosuppressive therapy for RA can influence thyroid function.
Epidemiologically, the burden is higher in developed regions where autoimmune diseases are more frequently diagnosed. However, underdiagnosis in low- and middle-income countries likely underestimates the true global impact.
Early screening of thyroid function in RA patients and autoantibody testing in AITD cases with joint pain are critical for timely detection. Public health strategies should include awareness programs, interdisciplinary management, and integration of autoimmune disease surveillance in global health systems.
Future research should focus on longitudinal cohort studies and the role of epigenetic and microbiome factors in the coexistence of these diseases.
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