Adrenal Insufficiency in Children with Juvenile Idiopathic Arthritis (JIA) Treated with Prednisolone

Abstract

Background: Corticosteroids are options for the treatment of juvenile idiopathic arthritis (JIA) although with adverse effects. Adrenal insufficiency (AI) may happen after therapeutic glucocorticoid administration. Objectives: We designed a study to assess the adrenal insufficiency in children with JIA undergoing treatment with low-dose glucocorticosteroids for at least six months. Methods: This cross-sectional study was conducted at Imam Khomeini hospital and Children Medical Center hospital on 36 JIA patients after at least three months of cessation of low-dose, long-term corticosteroid therapy. Data regarding age, sex, age at diagnosis, the subtype of disease, and duration of treatment with corticosteroid were recorded. Fasting cortisol and cortisol after ACTH administration were measured. The AI diagnosis was made if the first level of cortisol was less than 3 µg/dL and the second level was less than 20 µg/dL. Results: The sample included 25 women (69.4%) with an overall mean age of 8.2 ± 3.4 years. The mean age at the time of diagnosis was 6.3 ± 3.2 years. The type of disease was oligoarticular in 32 (88.9%) cases and systemic in four (11.1%). Four cases had AI, all of whom were female with oligo-articular arthritis. In all the four cases, the adrenal function became normal three months after prednisolone cessation. The age at the time of study and the age at the time of disease diagnosis were significantly different between cases with and without AI. Conclusions: Adrenal insufficiency is not prevalent in children with JIA treated with low-dose glucocorticoids for a short time.

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

“…If, despite recommendations against, oral glucocorticoids are given to quickly alleviate severe symptoms when an IAGC is not available or feasible, or prior to the onset of action of disease‐modifying antirheumatic drugs (DMARDs), treatment should be limited to the lowest effective dose for the shortest duration possible (20,21).…”

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

“…If, despite recommendations against, oral glucocorticoids are given to quickly alleviate severe symptoms when an IAGC is not available or feasible, or prior to the onset of action of disease-modifying antirheumatic drugs (DMARDs), treatment should be limited to the lowest effective dose for the shortest duration possible (20,21).…”