title: The clinical importance of the thyroid nodules during anti-tumor necrosis factor therapy in patients with axial spondyloarthritis.
abstract: The clinical importance of the thyroid nodules in patients with axial spondyloarthritis (ax-SpA) rests with the need to exclude thyroid malignancy. The aim of this study is to assess the risk of thyroid malignancy in ax-SpA patients receiving anti-TNF therapy. From September 2015 until December 2015, 70 patients diagnosed with ax-SpA were included in the research. Forty of the patients had received anti-TNF therapy, and 30 of the patients were anti-TNF naive. All cases were screened for the presence of nodules in the thyroid gland with ultrasound. Of the patients that received anti-TNF therapy, 15 (37.5%); and of the anti-TNF naive patients, 11 (36.7%) had thyroid nodule(s). Four patients from the anti-TNF group underwent fine needle aspiration biopsy of the nodules, and two of them were diagnosed with papillary thyroid carcinoma. None of the nodules in anti-TNF naive patients required biopsy. When compared to the normal population, the standardized incidence ratio (SIR) was found to be increased in both male (SIR 2.03, 95% CI 1.9 to 18) and female (SIR 2.7, 95% CI 2.6 to 24) cases. It is not yet established whether the development of cancer during the treatment process is the effect of the treatment or if it is a part of the natural course of the disease or if it is coincidental. We saw a mild increase in thyroid malignancies in ax-SpA patients who received anti-TNF therapy. Therefore, we believe that the thyroid gland should also be taken into consideration while screening for malignancy before anti-TNF therapy.
authors.affiliation: Cerrahpasa Medical Faculty, Physical Medicine and Rehabilitation, Rheumatology, Istanbul University, Istanbul, Turkey. ranakaynar@hotmail.com.
authors.forename: Rana
authors.initials: R
authors.lastname: Terlemez
authors.affiliation: Cerrahpasa Medical Faculty, Physical Medicine and Rehabilitation, Rheumatology, Istanbul University, Istanbul, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Akgün
authors.affiliation: Cerrahpasa Medical Faculty, Physical Medicine and Rehabilitation, Rheumatology, Istanbul University, Istanbul, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Palamar
authors.affiliation: Cerrahpasa Medical Faculty, Radiology, Istanbul University, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Boz
authors.affiliation: Cerrahpasa Medical Faculty, Physical Medicine and Rehabilitation, Rheumatology, Istanbul University, Istanbul, Turkey.
authors.forename: Hidayet
authors.initials: H
authors.lastname: Sarı
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D000068800:Etanercept / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D025241:Spondylarthritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014421:Turkey / Q000453:epidemiology; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Anti-TNF agent; Axial spondyloarthritis; Thyroid malignancy