Associations between thyrotropin receptor antibody, rheumatoid autoantibodies, and disease activity in patients with rheumatoid arthritis: a retrospective cross-sectional study
- 1Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
- 2Qianxinan Prefecture Hospital of Traditional Chinese Medicine, Xingyi, Guizhou, China
- 3The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
Abstract
Objective: Thyrotropin receptor antibody (TRAb) frequently coexists with rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) in patients with rheumatoid arthritis (RA), but its association with disease activity remains unclear. This study assessed the associations of TRAb and rheumatoid autoantibodies with DAS28-ESR in RA patients.
Methods: This retrospective cross-sectional study enrolled 192 RA patients hospitalized at the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between October 2024 and October 2025, all meeting the 2010 ACR/EULAR criteria. Patients were classified as TRAb-positive or TRAb-negative using the clinical cutoff of 1.75 IU/L. Associations between TRAb and DAS28-ESR were evaluated by Spearman correlation, restricted cubic spline (RCS) analysis, and multivariable linear regression. The primary analysis was repeated in euthyroid patients (n = 167). Interactions of TRAb with Ln(RF) and Ln(anti-CCP) were tested in all 192 patients, and an exploratory four-group comparison was performed in 138 patients with concordant antibody titers.
Results: TRAb correlated positively with DAS28-ESR (ρ=0.36, P < 0.001), and RCS analysis revealed a nonlinear association (P = 0.002 for nonlinear). hs-CRP, ESR, and DAS28-ESR were higher in TRAb-positive (n = 51) than TRAb-negative patients (n = 141; all P < 0.001). After covariate adjustment, TRAb positivity remained independently associated with higher DAS28-ESR (B = 1.457, P < 0.001), and the association persisted in euthyroid patients (4.9 vs. 4.1, P < 0.001). TRAb showed a statistically significant interaction with Ln(anti-CCP) (P = 0.0014) and a borderline interaction with Ln(RF) (P = 0.046); DAS28-ESR was highest in TRAb-positive patients with high-titer autoantibodies.
Conclusions: TRAb positivity was associated with higher disease activity and systemic inflammation in RA patients, including those with normal thyroid function, and the association strengthened with increasing rheumatoid autoantibody titers. The value of combined TRAb, RF, and anti-CCP testing for immune stratification in RA warrants prospective validation.
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BibTeX
@article{he2026associations,
title = {{Associations between thyrotropin receptor antibody, rheumatoid autoantibodies, and disease activity in patients with rheumatoid arthritis: a retrospective cross-sectional study}},
author = {Hongwei He and Qianqian Wang and Yun Lu and Yongqiang Zhang and Jiang Liang},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1970456},
url = {https://doi.org/10.3389/fmed.2026.1970456},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations between thyrotropin receptor antibody, rheumatoid autoantibodies, and disease activity in patients with rheumatoid arthritis: a retrospective cross-sectional study
AU - Hongwei He
AU - Qianqian Wang
AU - Yun Lu
AU - Yongqiang Zhang
AU - Jiang Liang
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1970456
UR - https://doi.org/10.3389/fmed.2026.1970456
AB - Objective: Thyrotropin receptor antibody (TRAb) frequently coexists with rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) in patients with rheumatoid arthritis (RA), but its association with disease activity remains unclear. This study assessed the associations of TRAb and rheumatoid autoantibodies with DAS28-ESR in RA patients. Methods: This retrospective cross-sectional study enrolled 192 RA patients hospitalized at the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between October 2024 and October 2025, all meeting the 2010 ACR/EULAR criteria. Patients were classified as TRAb-positive or TRAb-negative using the clinical cutoff of 1.75 IU/L. Associations between TRAb and DAS28-ESR were evaluated by Spearman correlation, restricted cubic spline (RCS) analysis, and multivariable linear regression. The primary analysis was repeated in euthyroid patients (n = 167). Interactions of TRAb with Ln(RF) and Ln(anti-CCP) were tested in all 192 patients, and an exploratory four-group comparison was performed in 138 patients with concordant antibody titers. Results: TRAb correlated positively with DAS28-ESR (ρ=0.36, P < 0.001), and RCS analysis revealed a nonlinear association (P = 0.002 for nonlinear). hs-CRP, ESR, and DAS28-ESR were higher in TRAb-positive (n = 51) than TRAb-negative patients (n = 141; all P < 0.001). After covariate adjustment, TRAb positivity remained independently associated with higher DAS28-ESR (B = 1.457, P < 0.001), and the association persisted in euthyroid patients (4.9 vs. 4.1, P < 0.001). TRAb showed a statistically significant interaction with Ln(anti-CCP) (P = 0.0014) and a borderline interaction with Ln(RF) (P = 0.046); DAS28-ESR was highest in TRAb-positive patients with high-titer autoantibodies. Conclusions: TRAb positivity was associated with higher disease activity and systemic inflammation in RA patients, including those with normal thyroid function, and the association strengthened with increasing rheumatoid autoantibody titers. The value of combined TRAb, RF, and anti-CCP testing for immune stratification in RA warrants prospective validation.
SN - 2296-858X
ER -