THE MEANING OF THE CHRONOLOGICAL PRIMACY OF THE DEBUT OF RHEUMATOID ARTHRITIS ASSOCIATED WITH AUTOIMMUNE THYROIDITIS
Known clusters of autoimmune diseases, which include rheumatoid arthritis. One of the most common combinations of rheumatoid arthritis with another autoimmune disease is its combination with autoimmune thyroiditis. Objective. To reveal the clinical and laboratory significance of the chronological primacy of rheumatoid arthritis associated with autoimmune thyroiditis. Materials and methods. The study included 53 patients with a combination of rheumatoid arthritis and autoimmune thyroiditis (mean age 63.92 ± 1.6 years, 92% of patients - women, duration of rheumatoid arthritis 10.0 ± 1.11 years, disease activity on the DAS28 scale - 5.67 ± 0.14 points). All patients underwent a general clinical study, including the collection of a specialized history, standard biochemical, immuno logical (determination of the titer of rheumatoid factor, antibodies to cyclic citrullinated peptide, antibodies to thyreoglobulin and antibodies to thyroid peroxidase), hormonal (determination of the level of thyroxine and thyroid-stimulating hormone) and instrumental Methods of research. To assess the importance of the chronological primaryity of the rheumatoid arthritis debut with respect to autoimmune thyroiditis, the patients were divided into two subgroups: 1) patients with primary rheumatoid arthritis, i. e. patients in whom the first documented diagnosis was rheumatoid arthritis (n = 20); 2) patients with secondary rheumatoid arthritis, i. e. patients in whom rheumatoid arthritis developed after a documented diagnosis of autoimmune thyroiditis (n = 33). Results. The level of TSH negatively correlated with acute phase indices in both groups, reaching a level statistically significant in the correlation between ESR and TSH in patients with secondary rheumatoid arthritis. Secondary rheumatoid arthritis had a higher level of antithyroid antibodies, a higher level of fasting glycemia and creatinine in the blood, as well as a direct reliable association of cholesterinemia with the level of antithyroid antibodies. Moreover, the percentage of centenarians in the family in this group was significantly higher. In patients who had an initial debut of the disease in the form of rheumatoid arthritis, there is a more pronounced activity of the immunological parameters of rheumatoid arthritis, reaching a level of statistical significance in terms of the level of ACCP and the frequency of RF-positive cases in comparison with the group of patients with secondary rheumatoid arthritis. Primary rheuma toid arthritis was also characterized by a higher incidence of ankylosis and systemic manifestations, as well as a more rapid course of the disease from the first manifestations to an expanded clinical picture and a frequent association of the onset of the disease with a previous infection. It is significant that in both groups the correlation analysis showed the presence of close direct correlation relationships between the level of TSH and the experience of smoking tobacco. Conclusion. The primary rheumatoid arthritis group is charac terized by higher rheumatological immunological activity and severity of the rheumatoid arthritis, and the secondary rheumatoid arthritis group is characterized by higher antithyroid immunological activity and a milder course of rheumatoid arthritis (4 tabl es, bibliog raphy: 23 refs).