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THU0387 The clinical importance of the thyroid nodules during tumor necrosis factor-alpha inhibitor therapy in patients with axial spondyloarthritis
  1. R Terlemez1,
  2. K Akgün2,
  3. D Palamar2,
  4. H Sarı2
  1. 1Physical medicine and rehabilitation, Şişli Hamidiye Etfal Research and Training Hospital
  2. 2Physical medicine and rehabilitation, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey


Background TNF is a pivotal regulator of inflammation and the cytokine system. Besides this, there is no doubt that TNF has a major role in cancer biology. TNF has a dual defensive and offensive role in carcinogenesis (1). TNF-blocking treatment has led to improvements in the management of inflammatory diseases.Even though their efficacy as anti-inflammatory drugs is well-proven, there are some concerns about the adverse effects of anti-TNF therapy (2). Basic research suggests that the evaluation of infections and malignancy as major adverse effects should be performed effectively (3). However, some studies conducted so far have dubious notions that anti-TNF therapy increases the risk of cancer (3,4).

Objectives Objective: 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.

Methods From September 2015 until December 2015, 70 patients diagnosed with ax-SpA according to ASAS criteria, were included in the research. Forty of the patients had received anti-TNF therapy, and 30 of the patients were anti-TNF naive. A clinician from the Physical Medicine and Rehabilitation clinic performed ultrasonography on all patients to screen for thyroid nodule(s). If thyroid ultrasonography revealed an abnormal finding, the patient was referred to a radiologist.

Results The mean (SD) age was 38±9.87 years; % 75.7 of the patients were male. None of the demographic differences between the groups were statistically significant. Fifteen of the forty patients that received anti-TNF therapy and eleven of the thirty anti-TNF naive patients had thyroid nodule(s). Four patients from the anti-TNF group underwent fine needle aspiration biopsy, 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.

Conclusions We see a mild increase in thyroid malignancies in ax-SpA patients that received anti-TNF therapy. Consequently, the thyroid gland should also be taken into consideration while screening for malignancy before anti-TNF therapy.


  1. Wajant, Harald. The role of TNF in cancer. Death Receptors and Cognate Ligands in Cancer. Springer Berlin Heidelberg, 2009. 1–15.

  2. Dixon, W. G., et al. Influence of anti-tumor necrosis factor therapy on cancer incidence in patients with rheumatoid arthritis who have had a prior malignancy: results from the British Society for Rheumatology Biologics Register. Arthritis care & research 62.6 (2010): 755–63.

  3. Bongartz, Tim, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. Jama 295.19 (2006): 2275–85.

  4. Askling, Johan, et al. Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists. Annals of the rheumatic diseases 2005;64:1421–6.


Disclosure of Interest None declared

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