Asian Journal of Healthy and
Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 3 No. June 6, 2024
Osteoarthritis and Hypothyroidism: What's the Association? A Literature Review
Erika
Yusticia Handayani1*, Heri Krisnata Ginting2
1,2 Universitas
Riau, Riau, Indonesia
Email: [email protected]1, [email protected]2
Osteoarthritis (OA) and hypothyroidism are two prevalent conditions
with interrelated mechanisms suggesting a potential connection between them. Several
studies have indicated that individuals with hypothyroidism are twice as likely to develop
OA in their knees compared to those
without hypothyroidism. Furthermore, individuals with hypothyroidism are more prone to
experiencing joint pain and stiffness,
possibly attributed to the effect
of thyroid hormone on bone
and cartilage proliferation and differentiation, thus increasing the risk of OA. Although
the precise relationship between OA and hypothyroidism remains incompletely understood, research underscores a significant association, suggesting a heightened risk of OA development in individuals with hypothyroidism. This research aims to
elucidate the mechanisms underlying this relationship and its implications
for managing OA in patients with hypothyroidism.
Keywords: Relationship, Osteoarthritis, Hypothyroidism, Mechanism.
INTRODUCTION
Osteoarthritis (OA) is a disease that affects the articular cartilage,
subchondral bone, synovium, capsule, and ligaments. The cartilage degenerates,
resulting in fibrillation, fissures, ulceration, and loss of full thickness on
the joint surface (Knecht et al., 2006). Risk factors for OA
include age, obesity, history of joint injury, and genetic factors. Hypothyroidism
occurs when the thyroid gland does not produce enough thyroid hormone (Hasan, 2016). Risk factors for hypothyroidism
include autoimmune thyroid disease, iodine deficiency, and radiation treatment
to the thyroid gland. Thyroid hormone plays an important role in maintaining
bone health by regulating bone formation and breakdown. Thyroid hormone
deficiency can disrupt this balance, causing decreased bone density and
increasing the risk of cartilage damage (Wojcicka et al., 2013a).
Although the relationship between OA and hypothyroidism is not fully
understood, research suggests a link between these two conditions. People with
hypothyroidism may have a higher risk of developing OA and may experience more
severe OA symptoms. The specific issue addressed in this research is the urgent
need to better understand the mechanisms underlying the relationship between OA
and hypothyroidism, which has significant implications for the prevention and
management of these conditions (Oo et al., 2018).
Previous research has explored the individual impacts of hypothyroidism
on bone health and the progression of OA, but comprehensive studies integrating
these aspects are limited. This research aims to fill that gap by investigating
the specific mechanisms and risk factors contributing to OA in individuals with
hypothyroidism (Medici et al., 2017). The novelty of this study
lies in its integrated approach to examining the intersection of OA and
hypothyroidism, providing new insights that could lead to improved prevention
strategies and enhanced quality of life for affected individuals.
This research aims to discuss the relationship between OA and
hypothyroidism, focusing on the mechanisms underlying this relationship and the
risk factors for developing OA in people with hypothyroidism (Mohajer et al., 2023a).
Understanding this relationship is crucial for developing more effective
prevention strategies for both conditions. The results of this study may help
improve the quality of life for people with OA and hypothyroidism.
RESEARCH METHODS
The literature
review method for investigating the relationship between osteoarthritis (OA) and hypothyroidism involved analyzing multiple studies to explore the
prevalence and mechanisms linking these conditions (B. Li et al.,
2024a). Several studies were reviewed to determine
the incidence of OA in individuals with hypothyroidism and vice versa.
For instance, a comprehensive
review by Moisescu-Pop et al. (2020) analyzed data from 11 studies involving 4,659 participants, revealing a higher prevalence of hypothyroidism
in OA patients compared to the general
population. Similarly, a retrospective cohort study by Wang et al.
(2021) examined a large healthcare database, finding a significantly higher incidence of OA in patients with hypothyroidism.
Mechanistic studies highlighted that thyroid hormone deficiencies disrupt bone metabolism, increase inflammation, and alter joint biomechanics, contributing to OA development. The review incorporated findings on the
impact of thyroid hormones on cartilage metabolism
and the role
of inflammatory mediators in exacerbating OA (F.-X.-Z. Li et al.,
2020). This methodical examination of epidemiological data, clinical studies, and mechanistic
insights provided a comprehensive understanding of the potential
link between OA and hypothyroidism, emphasizing the need for further
research to elucidate the underlying
pathways and improve clinical management strategies.
Hypothyroidism arises
when the thyroid gland fails
to generate adequate levels of thyroid hormone
(Dunn &
Turner, 2016). This condition, characterized by insufficient hormone production, can occasionally be triggered by
an enlarged thyroid gland, though this is
uncommon. Various external factors can also lead
to hypothyroidism, including past thyroid treatments, neck radiation, specific medications, and genetic disorders
(Chiovato et
al., 2019).
A comprehensive
review by Moisescu-Pop et al. (2020) investigated the occurrence of hypothyroidism among individuals with osteoarthritis (OA). Analyzing 11 studies encompassing 4,659 participants, the review revealed
that 12.1% of OA patients had hypothyroidism (95%
CI: 8.8-16.4%), a notably higher
rate than the general population's
prevalence of 2-5% (Chen et al.,
2022). The researchers concluded that OA patients face a significantly elevated risk of developing
hypothyroidism, with an odds ratio
of 1.55 (95% CI: 1.20-2.01).
Similarly, a retrospective cohort study by (Tagoe et al., 2021) analyzed
data from a large healthcare database in the United States. They found
that the incidence of OA was significantly higher in patients with hypothyroidism compared to those without the condition, with a hazard ratio of 1.24 (95% CI:
1.21-1.27). This study provided
further evidence for the potential
association between hypothyroidism and the development of OA (Mohajer et
al., 2023b).
While these
studies suggest a link between OA and hypothyroidism, the underlying mechanisms and the directionality of this relationship
are not yet fully understood. More research is needed to elucidate the epidemiological patterns, risk factors, and potential causal pathways that may connect these two conditions
(Penninx, 2017).
The
Relationship Between Osteoarthritis (Oa) And Hypothyroidism
Osteoarthritis (OA) and hypothyroidism are prevalent conditions that are interconnected beyond mere statistics, involving complex mechanisms (Sobieh et
al., 2023). Thyroid
hormones are crucial in bone metabolism regulation, particularly the bone remodeling
process. A deficiency in these hormones, like triiodothyronine (T3) and thyroxine (T4), disrupts the balance
between bone resorption and formation, reducing bone density. Chen et al.
explored the link between thyroid
hormone sensitivity and OA prevalence using NHANES 2007-2010 data. They found
that both peripheral and central thyroid resistance indices were significantly correlated with OA prevalence, with higher FT3/FT4 levels and lower
TSHI, TT4RI, and TFQI levels
being associated with increased OA risk. Kim et al.
also found that hypothyroid conditions were linked to a higher incidence
of knee osteoarthritis.
Devrimsel et al. noted that
hypothyroid patients had thinner femurs and a greater OA risk compared to
healthy individuals across all measured
sites (B. Li et al.,
2024b). Additionally, another study reported that FT3/FT4 levels declined as OA risk increased. Collectively, these findings underscore the potential role of thyroid hormone
sensitivity in predicting and assessing OA.
Thyroid hormone
deficiency can interfere with the production of collagen and
proteoglycans, this is important components
of cartilage (Wojcicka et
al., 2013b). This
can cause the cartilage to
become brittle and easily damaged,
triggering the development of OA. Hypothyroidism can increase inflammation throughout the body, including in the joints (Antonelli et
al., 2015). This
can lead to increased inflammatory
cytokines and immune cell infiltration.
Thyroid hormone deficiency can increase the production
of inflammatory cytokines, such as IL-1β and
TNF-α, which
can damage cartilage and other
joint tissue. Thyroid hormone deficiency can increase the infiltration
of inflammatory cells into the
joints, exacerbating inflammation and accelerating joint damage (Figus et al., 2021).
This hormone
helps regulate the immune system
and suppress inflammation. A lack of thyroid hormone
(hypothyroidism) can disrupt this balance
and increase inflammatory activity, including in the joints. Hypothyroidism can increase the
infiltration of inflammatory cells such as macrophages and lymphocytes into the joints
(Luty et al., 2019). These
cells release enzymes and chemicals
that can damage cartilage and other joint
tissue, accelerating joint damage and
the development of OA. And the
other study, thyroid hormone deficiency can cause decreased
protein synthesis and increased protein breakdown in muscles, leading to decreased muscle
mass. This can weaken the
strength and stability of the
joint, making it more susceptible to injury and
worsening OA pain and stiffness (Hafez et al.,
2014).
Thyroid hormones,
such as thyroxine
(T4) and triiodothyronine
(T3), play a crucial role in the maintenance and repair of articular cartilage. Thyroid hormones are involved in regulating the metabolism and structure of cartilage, as well as the balance between anabolic and catabolic processes within the joint
(Mohammed
& Al-Sari, n.d.).
Hypothyroidism, characterized
by a deficiency of thyroid hormones, can lead to alterations in
cartilage metabolism, increased inflammation, and ultimately, cartilage damage (Chen et al.,
2022). This is
because thyroid hormones are essential for the proper functioning of chondrocytes, the cells responsible for the production and maintenance of cartilage matrix.
Pathogenesis of
OA in the Context of Hypothyroidism
The underlying mechanisms by which hypothyroidism may contribute to the development
and progression of OA are not fully elucidated, but several potential pathways have been proposed (Mohammed
& Al-Sari, n.d.):
1. Impaired cartilage
metabolism: Hypothyroidism
can disrupt the balance between anabolic and catabolic processes in cartilage, leading to increased catabolism and decreased synthesis of extracellular matrix components, such as collagen and proteoglycans. This can result in
the gradual deterioration
of articular cartilage.
2. Heightened inflammation:
Hypothyroidism is linked to elevated
levels of inflammatory mediators like cytokines and chemokines. These inflammatory agents can accelerate
the onset of osteoarthritis by fostering cartilage
breakdown and joint inflammation.
3. Altered joint
biomechanics: Hypothyroidism
may lead to changes in the mechanical properties of cartilage, such as decreased tensile strength and increased stiffness, which can alter joint biomechanics and increase the risk of OA development.
4. Accelerated cartilage
aging: Thyroid hormones are also involved in the regulation of cellular senescence and aging processes. Hypothyroidism may accelerate the aging of chondrocytes, leading to premature cartilage degeneration and increased susceptibility to OA.
Clinical Implications
and Potential Therapeutic Considerations
The potential association between OA and hypothyroidism has clinical implications for the management and treatment of these conditions
(Cira et al., 2023).
1. Screening and
early detection: Given
the increased prevalence of hypothyroidism in individuals with OA, it may be beneficial to consider routine screening for thyroid dysfunction in OA patients, particularly those with atypical or severe symptoms.
2. Thyroid hormone
replacement therapy: Some studies have suggested that the treatment
of hypothyroidism with thyroid hormone replacement therapy may have a beneficial effect on the progression of OA. However, the evidence is still limited, and more research
is needed to fully understand
the impact of thyroid hormone replacement on OA outcomes.
3. Integrated management
approach: A multidisciplinary
approach that addresses both the OA and the underlying thyroid dysfunction may be more
effective in managing patients with these co-occurring conditions. This may involve a combination of pharmacological, non-pharmacological,
and lifestyle interventions tailored to the individual's needs.
CONCLUSION
The relationship between osteoarthritis (OA) and hypothyroidism are two common conditions, is not only statistical,
but also has complex and interrelated
mechanisms. Understanding these mechanisms is critical for
more accurate diagnosis and the development
of effective prevention strategies. Thyroid hormone plays an important
role in regulating bone metabolism, including the bone
remodeling process. Thyroid hormone deficiency can disrupt the balance
between bone resorption (breakdown) and bone formation
(formation). Understanding these mechanisms is critical for
more accurate diagnosis, development of preventive strategies, and effective treatment.
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Copyright holders:
Erika Yusticia Handayani, Heri Krisnata Ginting (2024)
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Asian Journal of Healthy and Science
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