Factors Associated with the Development of Adrenal Insufficiency in Patients with Juvenile Idiopathic Arthritis Who Received Systemic Corticosteroids

INTRODUCTION: 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 oligo- 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.
METHODS: Twenty-five children with AI (serum cortisol <18 µg/dL, 30 minutes after ACTH stimulation) and 25 children without AI were included in this study. Subjects’ characteristics, type of JIA, arthritis location, laboratory measurements, and number of joints involved were recorded. Type of glucocorticoid administered, treatment protocol, and cumulative steroid dose were recorded. The primary endpoint was the difference in clinical characteristics, laboratory measurements and systemic corticosteroid dose in children with and without AI.
RESULTS: Median cumulative steroid dose was significantly higher in patients with AI compared to those without [2500 (1370–4400) mg vs. 963 (650–2500) mg, p=0.010]. Patients with oligoarticular JIA had a 6.7-fold lower risk of AI compared to those with other JIA types (OR: 0.149, 95% CI: 0.035–0.643, p=0.011). Patients with higher cumulative steroid dose (>1000 mg) had a 7.5-fold higher risk of AI than patients with lower dose (OR: 7.500, 95% CI: 1.634–34.416, p=0.010).
DISCUSSION AND CONCLUSION: Our findings show that non-oligoarticular JIA and high cumulative steroid dose are predictive for AI development in this patient subset; thus, systemic corticosteroids should be reserved for more aggressive JIA types and cumulative dose should be limited to 1000 mg.