Dehydroepiandrostenedione sulphate (DHEAS) levels predict high risk of rheumatoid arthritis (RA) in subclinical hypothyroidism

Abstract

Introduction: The presence of rheumatism is well recognized in primary hypothyroidism. Dehydroepiandrstenedione sulphate (DHEAS) is associated with rheumatological diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This study aims to explore relationship between joint pains and DHEAS levels in primary hypothyroidism.

Methods: Retrospective study of 78 subjects with subclinical hypothyroidism, with TSH within reference range. The joint pains were evaluated by European Union League against rheumatism (EULAR-CSA) score and compared with serum DHEAS, RA factor, Anti-TPO antibody, highly sensitive C-recative protein (hsCRP), vitamin D levels.

Result: DHEAS levels <43.6 mcg/dl significantly predicted clinical features of pre RA as assessed by EULAR CSA criteria with acceptable specificity (82%). EULAR CSA score is fairly valid in assessing imminent RA in primary hypothyroidism.

Conclusion: Lower DHEAS predicts clinical features of imminent RA in subjects with primary hypothyroidism. This is akin to low DHEAS seen in many rheumatological disease with possibly similar mechanism. Another possibility is low DHEAS alters hepato-hypothalamo pituitary adrenal axis in presense of cytokines and induces a hitherto unrecognized state of pre rheumatoid arthritis like syndrome. Future studies on primary hypothyroidism should focus on role of lower DHEAS levels in inducing symptoms of fatigue and joint pains.

Fig 1. Study flow chart.

Of total 462 datasets screened, 78 datasets were included in present study.

Fig 2. Inverse correlation between age and DHEAS levels.

The correlation was weak (spearman rho coefficient of correlation = -0.241) but statistically significant (0.03).

Fig 3. Low DHEAS as predictor of rheumatism in primary hypothyroidism.

ROC curve for low DHEAS as a predictor of rheumatism in primary hypothyroidism. The AUC curve was 0.67 (C.I = 0.52–0.83, p = 0.021).The cut off point for <43.6 mcg/dl was found. DHEAS, 43.8 predicted CSA of >5 with 82% specificity but low sensitivity (52%).

Fig 4. Comparison of mean DHEAS according to CSA status.

CSA was considered present if CSA score was greater or equal to 4. The mean DHEAS of those with CSA present (125.29 +/- 26.81) was lower than those with CSA absent (80.60 = /- 10). However it was not statistically significant. (p = 0.17).