AUTOIMMUNE thyroid disorders are significantly more common in patients with systemic lupus erythematosus (SLE), but they do not appear to worsen disease outcomes, according to a recent case-control study. Researchers evaluated the prevalence and clinical impact of Autoimmune Polyendocrine Syndromes (APS) in a cohort of 417 patients with SLE and found that 11% also had another autoimmune glandular disorder, primarily autoimmune thyroiditis.
This observed prevalence of APS in patients with SLE is markedly higher than the estimated 0.005% in the general population. Among the 47 patients diagnosed with APS, 39 had Hashimoto thyroiditis, six had Graves’ disease, and three had type 1 diabetes mellitus. Most (45) were classified as having APS type 3, and two as APS type 4. Notably, no cases of APS types 1 or 2 were identified.
Despite the elevated rate of APS, comparisons between APS-positive and APS-negative patients with SLE revealed no significant differences in clinical presentation, serological markers, or disease activity. At the last clinical follow-up, roughly 80% of patients in both groups were in clinical remission. Additionally, about half of the patients, regardless of APS status, were still receiving steroid therapy.
One slight distinction was noted in the median damage index (SLICC-SDI), which was marginally higher in APS-positive patients. However, this increase was not linked to more severe disease or an elevated rate of complications, suggesting that APS, while prevalent, may not influence the overall trajectory of SLE.
These findings reinforce the known association between SLE and autoimmune thyroid disease, particularly Hashimoto thyroiditis, and underscore the importance of endocrine surveillance in this patient population. However, the absence of a negative impact on disease progression offers reassurance to clinicians managing SLE with coexisting endocrine autoimmunity.
Reference:
Piovani E et al. A case-control study on autoimmune polyendocrine syndromes in patients with systemic lupus erythematosus. Rheumatology (Oxford). 2025:keaf320. [Online ahead of print]
