methimazole and Arthritis--Rheumatoid

Although type 1 diabetes mellitus is largely associated with autoimmune thyroid disease and this entity has been recently referred to as autoimmune polyglandular syndrome type 3 variant, the autoimmune polyglandular syndrome type 3 variant in patients with rheumatoid arthritis has not been reported so far. We herein describe the first case of rheumatoid arthritis that was associated with autoimmune polyglandular syndrome type 3 variant.. A 77-year-old woman with a 15-year history of rheumatoid arthritis (RA) and a 10-year history of type 2 diabetes mellitus (T2D) presented with polyarthralgia and hyperglycaemia. Methotrexate 16 mg/week had been started from the onset and was continued, and adalimumab 40 mg/day was started for RA. Insulin treatment was also started for the diabetes. Laboratory examinations revealed high levels of C-reactive protein (CRP), rheumatoid factor, anti-cyclic citrullinated peptide antibody, and matrix metalloprotease 3. She was admitted multiple times as the symptoms recurred after treatment. Subsequently, based on the clinical course and investigations, she was diagnosed with type 1 diabetes mellitus and Graves' disease occurring during the course of RA and T2D. Her clinical course improved after reinforcement of insulin therapy and the addition of thiamazole therapy.. In patients with rheumatoid arthritis, the autoimmune polyglandular syndrome type 3 variant should be considered as the cause of the deterioration.

Topics: Aged; Antirheumatic Agents; Antithyroid Agents; Arthritis, Rheumatoid; Diabetes Mellitus, Type 1; Female; Graves Disease; Humans; Hypoglycemic Agents; Insulin; Methimazole; Polyendocrinopathies, Autoimmune

We report a 40-year-old woman with onset of oligoarthritis shortly after initiating treatment with methimazole for Graves disease. Over the course of 7 years, her arthritis became progressively severe, leading to a diagnosis of seronegative rheumatoid arthritis. Treatment with disease-modifying antirheumatic agents and surgical intervention was contemplated. Ultrasound and magnetic resonance imaging revealed exuberant synovitis, involving right elbow and knees. Upon withdrawal of methimazole, prompt resolution of all signs and symptoms of arthritis was observed within several weeks. Following a MEDLINE search of available literature concerning antithyroid drug-induced arthritis, it is evident that this case represents the lengthiest duration of inflammatory arthropathy ever described in a patient that nonetheless was rapidly reversible with discontinuation of methimazole.

Topics: Adult; Antithyroid Agents; Arthritis, Rheumatoid; Chronic Disease; Diagnosis, Differential; Female; Graves Disease; Humans; Methimazole

Topics: Adult; Antithyroid Agents; Arthritis, Rheumatoid; Complement System Proteins; Female; Humans; Hyperthyroidism; Methimazole; Propylthiouracil; Thyroxine; Triiodothyronine

Topics: Adolescent; Arthritis, Rheumatoid; Female; Humans; Hyperthyroidism; Indians, North American; Lupus Erythematosus, Systemic; Methimazole; Neutrophils