Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids
Aim:In juvenile idiopathic arthritis (JIA), systemic corticosteroids are reserved for cases with serious organ involvement, those with macrophage activation syndrome, and in the presence of high disease activity in oligoarticular and polyarticular JIA. However, systemic steroids may lead to serious...
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| Format: | Article |
| Language: | English |
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Galenos Yayinevi
2023-03-01
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| Series: | Journal of Pediatric Research |
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| Online Access: |
http://jpedres.org/archives/archive-detail/article-preview/factors-associated-with-the-development-of-adrenal/58766
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| _version_ | 1811161478954221568 |
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| author | Gizem Zengin Ersoy Müferet Ergüven Metin Yıldız |
| author_facet | Gizem Zengin Ersoy Müferet Ergüven Metin Yıldız |
| author_sort | Gizem Zengin Ersoy |
| collection | DOAJ |
| description | Aim:In juvenile idiopathic arthritis (JIA), systemic corticosteroids are reserved for cases with serious organ involvement, those with macrophage activation syndrome, and in the presence of high disease activity in oligoarticular and polyarticular JIA. However, systemic steroids may lead to serious side effects linked to adrenal insufficiency (AI). This study aimed to investigate factors related to AI in children with JIA who received systemic steroids.Materials and Methods:Twenty-five children with AI (serum cortisol <18 μg/dL 30 minutes after adrenocorticotropic hormon stimulation) and 25 children without AI were included in this study. The subjects’ characteristics, type of JIA, arthritis location, laboratory measurements, and number of joints involved were recorded. The type of glucocorticoid administered, the treatment protocol, and the cumulative steroid dose were recorded. The primary endpoint was the difference in clinical characteristics, laboratory measurements and systemic corticosteroid dose in those children with or without AI.Results:The median cumulative steroid dose was significantly higher in those patients with AI compared to those without [2,500 (1,370-4,400) mg vs. 963 (650-2,500) mg, p=0.010]. Patients with oligoarticular JIA had a 6.7-fold lower risk of AI compared to those with other JIA types [odds ratio (OR): 0.149, 95% confidence interval (CI): 0.035-0.643, p=0.011]. Those patients with higher cumulative steroid doses (>1,000 mg) had a 7.5-fold higher risk of AI than those with lower doses (OR: 7,500, 95% CI: 1,634-34,416, p=0.010).Conclusion:Our findings show that non-oligoarticular JIA and high cumulative steroid doses are predictive for AI development in this patient subset; thus, systemic corticosteroids should be reserved for more aggressive JIA types and the cumulative dose should be limited to 1,000 mg. |
| first_indexed | 2024-04-10T06:14:52Z |
| format | Article |
| id | doaj.art-374e4fd8258a40e29edd51ca5cb0e1e6 |
| institution | Directory Open Access Journal |
| issn | 2147-9445 2587-2478 |
| language | English |
| last_indexed | 2024-04-10T06:14:52Z |
| publishDate | 2023-03-01 |
| publisher | Galenos Yayinevi |
| record_format | Article |
| series | Journal of Pediatric Research |
| spelling | doaj.art-374e4fd8258a40e29edd51ca5cb0e1e62023-03-02T08:20:57ZengGalenos YayineviJournal of Pediatric Research2147-94452587-24782023-03-01101263310.4274/jpr.galenos.2022.0420713049054Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic CorticosteroidsGizem Zengin Ersoy0Müferet Ergüven1Metin Yıldız2 Altınbaş University Bahçelievler Medical Park Hospital, Clinic of Pediatric Hematology, Oncology and Pediatric Bone Marrow Transplantation, İstanbul, Turkey Düzce University Faculty of Medicine, Department of Pediatric Rheumatology, Düzce, Turkey İstanbul Medeniyet University Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey Aim:In juvenile idiopathic arthritis (JIA), systemic corticosteroids are reserved for cases with serious organ involvement, those with macrophage activation syndrome, and in the presence of high disease activity in oligoarticular and polyarticular JIA. However, systemic steroids may lead to serious side effects linked to adrenal insufficiency (AI). This study aimed to investigate factors related to AI in children with JIA who received systemic steroids.Materials and Methods:Twenty-five children with AI (serum cortisol <18 μg/dL 30 minutes after adrenocorticotropic hormon stimulation) and 25 children without AI were included in this study. The subjects’ characteristics, type of JIA, arthritis location, laboratory measurements, and number of joints involved were recorded. The type of glucocorticoid administered, the treatment protocol, and the cumulative steroid dose were recorded. The primary endpoint was the difference in clinical characteristics, laboratory measurements and systemic corticosteroid dose in those children with or without AI.Results:The median cumulative steroid dose was significantly higher in those patients with AI compared to those without [2,500 (1,370-4,400) mg vs. 963 (650-2,500) mg, p=0.010]. Patients with oligoarticular JIA had a 6.7-fold lower risk of AI compared to those with other JIA types [odds ratio (OR): 0.149, 95% confidence interval (CI): 0.035-0.643, p=0.011]. Those patients with higher cumulative steroid doses (>1,000 mg) had a 7.5-fold higher risk of AI than those with lower doses (OR: 7,500, 95% CI: 1,634-34,416, p=0.010).Conclusion:Our findings show that non-oligoarticular JIA and high cumulative steroid doses are predictive for AI development in this patient subset; thus, systemic corticosteroids should be reserved for more aggressive JIA types and the cumulative dose should be limited to 1,000 mg. http://jpedres.org/archives/archive-detail/article-preview/factors-associated-with-the-development-of-adrenal/58766 juvenile idiopathic arthritissystemic corticosteroidsadrenal insufficiency |
| spellingShingle | Gizem Zengin Ersoy Müferet Ergüven Metin Yıldız Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids Journal of Pediatric Research juvenile idiopathic arthritis systemic corticosteroids adrenal insufficiency |
| title | Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids |
| title_full | Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids |
| title_fullStr | Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids |
| title_full_unstemmed | Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids |
| title_short | Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids |
| title_sort | factors associated with the development of adrenal insufficiency in patients with juvenile idiopathic arthritis who received systemic corticosteroids |
| topic | juvenile idiopathic arthritis systemic corticosteroids adrenal insufficiency |
| url |
http://jpedres.org/archives/archive-detail/article-preview/factors-associated-with-the-development-of-adrenal/58766
|
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