Endocrine Abstracts (2017) 49 EP1333 | DOI: 10.1530/endoabs.49.EP1333

Low DHEAS levels predict rheumatism in primary hypothyroidism: preliminary data from tertiary hospital

Ravindra Shukla, Praveen Sharma, Vikram Singh & Gopal Vohra

AIIMS, Jodhpur, Jodhpur, India.

Introduction: DHEAS is weak androgen with specific role in human physiology illdefined. Various studies have implicated role of DHEAS in autoimmune arthritis including SLE and RA. Recently EULAR consensus statement has approved CSA (clinically significant arthralgia) for incipient RA.

Methods and material: 34 follow up patients of primary hypothyroidism rated their symptom score on CSA (clinically suspect arthralgia) as given by EULAR(1) Their DHEAS levels were divided into quartiles while CSA was graded from 100 sensitivity (when one component is positive) to 100 specificity (when all seven component are positive). Kendal tau test of correlation was run using SPSS 21. ROC curve for DHEAS to predict at least one symptom of CSA was run. SPSS version 20 used for analysis.

Results: Anti TPO Ab were available for 19 subjects, out of which 16 were Anti TPO Ab+. 25(OH) vitamin D levels were available for only seven patients hence excluded from analysis. Kendal’s tau correlation test yieldedstrong negative correlation between DHEAS levels at the time of presentation and CSA score.{P<0.01; r −0.512}.

Discussion: This the first study evaluating role of DHEAS in rheumatism of primary hypothyroidism. Musculoskeletal abnormalities arecommon in primary autoimmune thyroid disease (AITD); 2) AITD is also associated with rheumatoid arthritis (RA); 3) There has been recent acknowledgement of role of local androgen in molecular pathogenesis of autoimmune arthritis; 4) We found inverse correlation between serum DHEAS and rheumatism. The serum DHEAS levels seemed to predict grade of rheumatism in these patients. The finding and strength of association is significant and opens further avenues for research regarding role of DHEAS in musculoskeletal manifestations of AITD. DHEAS supplementation has been evaluated in SLE (4) but not in hypothyroidism. Although association between Rheumatoid arthritis (RA) and DHEAS is not well defined, improvement in RA is associated with increase in DHEAS levels (5) Does DHEAS supplementation early in RA or pre –RA alters its natural history, in background of hypothyroidism? Well designed studies are needed.

Conclusion: Rheumatism as evaluated by CSA criteria bears strong inverse correlation with DHEAS. Further trials examining role of DHEAS in such group of patients can be explored.

Reference: 1) van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJ, Brouwer E, Codreanu C, Combe B, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Annals of the Rheumatic Diseases. 2016 October 6.

2) Radu L, Groppa L, Vudu L. Musculoskeletal impairement in primary hypothyroidism. Rev Med Chir Soc Med Nat Iasi. 2016 April–June; 120 244–251.

3) Jorge Cárdenas Roldán, Jenny Amaya-Amaya, Juan Castellanos-de la Hoz, et al., Autoimmune thyroid disease in rheumatoid arthritis: a global perspective, Arthritis, 2012. doi:10.1155/2012/864907

4) Amr H Sawalha, Susan Kovats. Dehydroepiandrosterone in systemic lupus erythematosus. Current Rheumatology Reports. 2008 August 10 286–291.

5) Ernestam S1, Hafström I, Werner S, Carlström K, Tengstrand B. Increased DHEAS levels in patients with rheumatoid arthritis after treatment with tumor necrosis factor antagonists: evidence for improved adrenal function. Journal of Rheumatology. 2007 July; 34 1451–1458.

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