Psoriatic arthritis and Hashimoto's thyroiditis in a patient presenting with major depression and subclinical hyperthyroidism: A case report
Abstract
Psoriatic arthritis (PsA) is a chronic, deforming arthritis associated with psoriatic skin lesions. Numerous patients with PsA carry other co-existing chronic diseases, adding to their overall disease burden and affecting the patient’s quality of life. Depression is a common illness known to coexist in about 20% of patients with PsA. Long-term inflammation conditions can make patients more depressed and make the treatment more difficult. Cushing Syndrome (CS) is a complication of long-term treatment due to the exposure of glucocorticoids given to turn the hypothyroid condition into hyperthyroid because hypercortisolism in humans lowers TSH secretion and TSH pulse amplitude. When PsA combines with depression and CS, it will create complex conditions and treatments. The complexity is all about how we control the disease activity of PsA and the vicious circle of an inflammatory process that is difficult to control. Conventional treatment will fail, and targeted therapy with monoclonal antibodies such as anti-IL-17 Secukinumab, is needed. Secukinumab as an anti-IL-17 will block the inflammation pathway from interleukin-17, decrease the inflammation process, and improve the symptoms of PsA. We report a patient with psoriatic arthritis and Hashimoto's thyroiditis (HT) with a major depressive episode with CS and subclinical hyperthyroidism successfully treated with Secukinumab.
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References
Armstrong, A. W., & Read, C. (2020). Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA: The Journal of the American Medical Association, 323(19), 1945–1960. https://doi.org/10.1001/jama.2020.4006
Bai, F., Li, G. G., Liu, Q., Niu, X., Li, R., & Ma, H. (2019). Short-Term Efficacy and Safety of IL-17, IL-12/23, and IL-23 Inhibitors Brodalumab, Secukinumab, Ixekizumab, Ustekinumab, Guselkumab, Tildrakizumab, and Risankizumab for the Treatment of Moderate to Severe Plaque Psoriasis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Journal of Immunology Research, 2019, 2546161. https://doi.org/10.1155/2019/2546161
Barbot, M., Zilio, M., & Scaroni, C. (2020). Cushing’s syndrome: Overview of clinical presentation, diagnostic tools and complications. Best Practice & Research. Clinical Endocrinology & Metabolism, 34(2), 101380. https://doi.org/10.1016/j.beem.2020.101380
Beurel, E., Toups, M., & Nemeroff, C. B. (2020). The Bidirectional Relationship of Depression and Inflammation: Double Trouble. Neuron, 107(2), 234–256. https://doi.org/10.1016/j.neuron.2020.06.002
Coates, L. C., FitzGerald, O., Helliwell, P. S., & Paul, C. (2016). Psoriasis, psoriatic arthritis, and rheumatoid arthritis: Is all inflammation the same? Seminars in Arthritis and Rheumatism, 46(3), 291–304. https://doi.org/10.1016/j.semarthrit.2016.05.012
Coates, L. C., Soriano, E. R., Corp, N., Bertheussen, H., Callis Duffin, K., Campanholo, C. B., Chau, J., Eder, L., Fernández-Ávila, D. G., FitzGerald, O., Garg, A., Gladman, D. D., Goel, N., Helliwell, P. S., Husni, M. E., Jadon, D. R., Katz, A., Laheru, D., Latella, J., … GRAPPA Treatment Recommendations domain subcommittees. (2022). Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nature Reviews. Rheumatology, 18(8), 465–479. https://doi.org/10.1038/s41584-022-00798-0
Haddad, A., Ashkenazi, R. I., Bitterman, H., Feldhamer, I., Greenberg-Dotan, S., Lavi, I., Batat, E., Bergman, I., Cohen, A. D., & Zisman, D. (2017). Endocrine Comorbidities in Patients with Psoriatic Arthritis: A Population-based Case-controlled Study. The Journal of Rheumatology, 44(6), 786–790. https://doi.org/10.3899/jrheum.161274
Hasenmajer, V., Sbardella, E., Sciarra, F., Minnetti, M., Isidori, A. M., & Venneri, M. A. (2020). The Immune System in Cushing’s Syndrome. Trends in Endocrinology and Metabolism: TEM, 31(9), 655–669. https://doi.org/10.1016/j.tem.2020.04.004
Köhler-Forsberg, O., N Lydholm, C., Hjorthøj, C., Nordentoft, M., Mors, O., & Benros, M. E. (2019). Efficacy of anti-inflammatory treatment on major depressive disorder or depressive symptoms: meta-analysis of clinical trials. Acta Psychiatrica Scandinavica, 139(5), 404–419. https://doi.org/10.1111/acps.13016
Mathew, A. J., & Chandran, V. (2020). Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation. Rheumatology and Therapy, 7(2), 287–300. https://doi.org/10.1007/s40744-020-00207-6
Nieman, L. K. (2015). Cushing’s syndrome: update on signs, symptoms and biochemical screening. European Journal of Endocrinology / European Federation of Endocrine Societies, 173(4), M33–M38. https://doi.org/10.1530/EJE-15-0464
Paragliola, R. M., Corsello, A., Papi, G., Pontecorvi, A., & Corsello, S. M. (2021). Cushing’s Syndrome Effects on the Thyroid. International Journal of Molecular Sciences, 22(6). https://doi.org/10.3390/ijms22063131
Petramala, L., Olmati, F., Conforti, M. G., Concistré, A., Bisogni, V., Alfieri, N., Iannucci, G., de Toma, G., & Letizia, C. (2018). Autoimmune Diseases in Patients with Cushing’s Syndrome after Resolution of Hypercortisolism: Case Reports and Literature Review. International Journal of Endocrinology, 2018. https://doi.org/10.1155/2018/1464967
Santos, A., Webb, S. M., & Resmini, E. (2021). Psychological complications of Cushing’s syndrome. Current Opinion in Endocrinology, Diabetes, and Obesity, 28(3), 325–329. https://doi.org/10.1097/MED.0000000000000633
Weetman, A. P. (2021). An update on the pathogenesis of Hashimoto’s thyroiditis. Journal of Endocrinological Investigation, 44(5), 883–890. https://doi.org/10.1007/s40618-020-01477-1
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Copyright (c) 2023 Lita Diah Rahmawati, Bagus Aulia Mahdi

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