Q:  Associations between Rheumatoid Arthritis, BP and Thyroiditis?

Dear Dr. Phelps,

I was diagnosed with bipolar at the age of 48 and took lithium and a series of SSRI's along with it ending in Prozac and then came down with a serious, all over the body, rheumatoid arthritis.  I got control of the RA by not taking any bipolar medications and taking minocycline 100 mg. twice daily and dicloflenic 75 mg. also twice daily.  

I have been on and off virtually every medication for bipolar but all end up making my rheumatoid arthritis (RA) worse. Last year I started a course of trileptal 300 mg. twice daily and my RA got so severe that I was nearly in a wheelchair and the pain was unbearable.  I went off the trileptal but now have the bipolar symptoms and cannot manage them very well.

Have you any knowledge of these comorbid associations like RA and bipolar and the bipolar meds affecting the RA so badly?  Or have you any suggestions for me.

Many thanks,


Ms. B.'s second letter:

Hi, I just last evening wrote Dr. John Phelps about my  bipolar/rheumatoid arthritis problems. I have since read his  article on  bipolar/BPD and wanted to say that I also have Hashimoto's thyroiditis. I  wondered if somehow all 3 things were involved: not being able to take meds,  having the RA flare if I do, and having Hashimotos thyroiditis? 

Many thanks,


Dear Ms. B.--

I can certainly understand why you would think there was some connection between the bipolar disorder and rheumatoid arthritis; and especially that somehow the thyroiditis might play a role.  Unfortunately, I am unaware of any connection in the literature.a quick literature search (rheumatoid arthritis bipolar) yielded no articles on a connection. I am sure there is more data connecting the arthritis in the thyroid problem as both are autoimmune phenomena; and perhaps one could somehow thus connect indirectly to bipolar disorder through the thyroid condition.  However, such speculation is unlikely to lead to any particular new ideas for treatment beyond simply considering thyroid approaches as described on my page about thyroid and bipolar disorder (unlikely, because the connection between thyroid and bipolar disorder is so fuzzy, itself).  Perhaps something in there may be of some use to you.  Good luck with that.

Dr. Phelps