Serologic Screening Recommended for Patients With JIA With Family History of Thyroid Disease

Patients with juvenile idiopathic arthritis (JIA) with a family history of autoimmune thyroid disease (AITD), as well as an antinuclear antibody (ANA)-positive status, are more likely to develop AITD, according to study findings published in Pediatric Rheumatology.

Researchers aimed to gain insight into the prevalence of AITD, including nonspecified AITD, Hashimoto thyroiditis, and Graves’ disease, among patients with JIA.

Data on comorbidities and adverse events were collected from the international Pharmachild registry, which includes demographic data of patients with JIA from 85 Paediatric Rheumatology International Trials Organisation (PRINTO) centers worldwide.

Univariable and multivariable logistic regression analyses were performed to assess factors and independent predictors of developing AITD.

Of a total of 8965 patients with AITD (68.1% girls; 86.9% European) identified through the registry, across a median 5.5-year span, the researchers observed that 1.1% (n=96) had an AITD. Of individuals diagnosed with AITD, 35.4% (n=34) were unspecified cases of AITD; 60.4% (n=58/ 96) had Hashimoto thyroiditis; and 4.2% (n=4) had Graves’ disease.

Significant risk factors for developing vs not developing AITD included ANA positivity (55.7% vs 41.5%), the female sex (83.3% vs 68.0%), and rheumatoid factor (RF) positivity (10.0% vs 4.3%). Compared with patients without AITD, those who developed AITD were more likely to be older at JIA symptom onset (median, 5.3 vs 7.8 years), have a higher incidence of polyarthritis (30.4% vs 40.6%), and have a family history of AITD (4.8% vs 27.5%).

Results of the multivariable analysis revealed that ANA positivity (odds ratio [OR], 2.0; 95% CI, 1.3-3.2), the female sex (OR, 2.2; 95% CI, 1.3-4.3), a family history of AITD (OR, 6.8; 95% CI, 4.1-11.1), and older age at JIA onset (OR, 1.1; 95% CI, 1.1-1.2) were all independent predictors for the development of AITD.

Furthermore, patients with vs without AITD had a significantly higher incidence of celiac disease (4.2% vs 0.6%; P <.01) and diabetes (2.1% vs 0.3 %; P =.04).

A major study limitation included the predisposition toward patients with more severe forms of JIA, making it more challenging to apply the results to all individuals with varying severity levels of JIA. In addition, the actual prevalence of AITD may be underestimated as indicators regarding baseline comorbidities and adverse events were collected by physician reporting. Due to missing AITD-onset dates, no correlation between disease activity and AITD onset, drug therapy, and duration could be established.

The study authors noted, “These results provide evidence for the added value of yearly serological screening for AITD in ANA positive girls with positive family history, in order to guide a practical approach to the pediatric patient with JIA at risk of developing AITD.”

In addition, the researchers suggested that drug therapy treatments should be explored, along with the disease duration, to identify other significant predictive factors related to AITD in patients with JIA.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of author’s disclosures.