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The Link Between Hashimoto's and Rheumatoid Arthritis

Learn why people with Hashimoto's often have other autoimmune disorders like rheumatoid arthritis.
The Link Between Hashimoto's and Rheumatoid Arthritis
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Autoimmune disorders tend to travel in packs, meaning that people with an autoimmune condition usually have more than one. Two of the most common conditions are Hashimoto's thyroiditis and rheumatoid arthritis. If you have one of these conditions or a family history of either, read on for what you need to know about how you can best manage Hashimoto's thyroiditis and rheumatoid arthritis.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is one of the most common autoimmune diseases. In RA, the body's immune system attacks the lining of your joints (called the synovial membrane), causing severe chronic inflammation that can be debilitating and painful. Inflammation from RA can also infiltrate other organs, including your heart, eyes, and skin tissues. If left unmanaged, the disease can progress to destroying the cartilage and bone in the joints. 

Per the Arthritis Foundation, 1.5 million Americans have been diagnosed with RA. However, there are likely many more people with it who have not been diagnosed. 

Common symptoms of rheumatoid arthritis include:

  • Pain
  • Joint stiffness
  • Swelling
  • Redness
  • Warmth on the joints
  • Reduced range of motion 

There are some risk factors for rheumatoid arthritis, including:

  • Having a family member with RA
  • Age (your risk increases with age, although it can show up in children and young adults as well)
  • Being female
  • Obesity
  • Having a joint injury
  • Having other autoimmune conditions

To know if you have rheumatoid arthritis, you need to see a doctor like a primary care provider or a rheumatologist. They will examine your joints for swelling, redness, and heat and will also consider ordering blood work and imaging studies.

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What is Hashimoto's thyroiditis?

Hashimoto's thyroiditis is an autoimmune condition where the immune system attacks cells in the thyroid gland. Over time, this can cause chronic inflammation and eventual thyroid failure. Therefore, people with Hashimoto's often develop hypothyroidism because their thyroid gland cannot produce thyroid hormone, which helps control metabolism.

Often, Hashimoto's goes undetected until a person develops an underactive thyroid. Therefore, people with this condition develop symptoms of hypothyroidism.

Common symptoms of hypothyroidism include:

  • Weight gain
  • Fatigue
  • Cold intolerance
  • Muscle weakness
  • Muscle and joint pain
  • Swelling
  • Depression and low mood
  • Slowed heart rate
  • Hair thinning or hair loss
  • Dry skin

Suppose you or your doctor suspect you have Hashimoto's. In that case, you should order a complete thyroid panel to check your thyroid hormone levels and TPO antibodies, which help indicate if there is an autoimmune process at play. 

Why do rheumatoid arthritis and Hashimoto's often coexist?

The big question we all want to know is why Hashimoto's and rheumatoid arthritis often show up together. Exactly how these two conditions work together is not completely clear. Still, we know that rheumatoid arthritis is a risk factor for Hashimoto's. Likewise, Hashimoto's increases your risk of developing rheumatoid arthritis. 

The leading theory as to why these two diseases occur in the same person comes down to genetics. Researchers suspect that there is a genetic predisposition for the two diseases on the HLA genetic sequence. HLA stands for the Human Leukocyte Antigen System, which plays an essential role in regulating the immune system. Many autoimmune disorders, including type 1 diabetes and psoriasis, also show defects in this genetic sequence.

Aside from your genes, evidence suggests that environmental factors and stress also increase your risk for autoimmune diseases. For example, infections, exposure to toxins, and dietary habits may play a role in autoimmune diseases. In response to these stressors, the immune system develops "self-antigens" that can lead to tissue destruction. 

Are thyroid joint symptoms a sign of rheumatoid arthritis?

Hashimoto's and rheumatoid arthritis share some common symptoms, with joint pain being the most obvious. If you have a thyroid disorder and struggle with joint pain, first make sure you are on the correct dose of thyroid medication by checking your thyroid labs

If your thyroid looks well controlled and you still have joint pain, it is essential to let your doctor know to consider other conditions behind it. Early action is key to preserving your joints and mobility. 

Aside from joint pain, both Hashimoto's and rheumatoid arthritis share the following symptoms:

  • Fatigue
  • Depression
  • Swelling in the feet and legs
  • Muscle discomfort
  • Weight gain

Because there are similarities in symptoms between these two autoimmune diseases, it is important to get the proper diagnostic tests to help make a diagnosis. Indeed, many doctors will order a TSH on all of their patients with RA to make sure they do not have underlying Hashimoto's. 

How do you control joint pain in both conditions?

People who have a thyroid disorder and rheumatoid arthritis are likely to have more aggressive disease progression and poorer responses to treatment. What this means is that it can be hard to manage them. So, suppose you do have both conditions. In that case, you will want to stay on top of your routine testing, follow-up consultations, medications, and lifestyle interventions

Take your medication

Both diseases usually require some support from medication. Fortunately, common drugs for both conditions do not usually interact, so you should be able to treat both simultaneously. Make sure to follow your doctor's orders when taking your medication.

Medication for Rheumatoid arthritis

There is no cure for RA, so the goal is to get your disease into remission, where you have no symptoms or at least control over them. Medical treatment of RA includes anti-inflammatory medications, steroids, DMARDs that can slow disease progression, and biological drugs.

Medication for Hashimoto's thyroiditis

Suppose you have an underactive thyroid due to your Hashimoto's. In that case, you need to take a thyroid hormone replacement medication like levothyroxine. People on this medication need to take it for the rest of their life, and there are some specific guidelines like taking it on an empty stomach. 


12 Week Hashimoto's
Health Plan


Other interventions

Medications are a great tool, but it is not the end-all, be-all answer for most people with RA or Hashimoto's. Therefore, you want to establish some healthy habits like:

  • Eating an anti-inflammatory diet
  • Getting plenty of sleep
  • Staying active
  • Keeping your weight in check
  • Reducing and managing stress levels
  • Doing activities that boost your mood

Paloma Health thyroid doctors have experience in helping people who live with multiple autoimmune disorders. Meet with a Paloma Health thyroid doctor to take back control of your thyroid health, so you can better manage your other health conditions. 


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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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