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

Abstract

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 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.

Keywords

• juvenile idiopathic arthritis
• systemic corticosteroids
• adrenal insufficiency