Risk of Adrenal Insufficiency in Patients with Polymyalgia Rheumatica Versus Patients with Rheumatoid Arthritis: A Cross-Sectional Study

• Published in: Modern rheumatology Vol. 32; no. 5; pp. 891 - 898
• Main Authors: Kasahara, Akiko, Kida, Takashi, Hirano, Aiko, Omura, Satoshi, Sofue, Hideaki, Sakashita, Aki, Sagawa, Tomoya, Asano, Mai, Fukui, Michiaki, Wada, Makoto, Kohno, Masataka, Kawahito, Yutaka
• Format: Journal Article
• Language: English
• Published: England 20.08.2022
• Subjects: glucocorticoid; Adrenal insufficiency; rheumatoid arthritis; adrenocorticotropic hormone test; polymyalgia rheumatica
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1093/mr/roab091

To determine whether patients with polymyalgia rheumatica (PMR) are more susceptible to glucocorticoid-induced adrenal insufficiency, one of the barriers to glucocorticoid tapering strategies, compared to patients with rheumatoid arthritis (RA). This cross-sectional study included PMR and RA patients who underwent adrenocorticotropic hormone (ACTH) tests to assess adrenal function. The eligibility criteria were as follows: previous use of prednisolone (PSL) ≥ 5 mg/day, use of PSL for 6 consecutive months before ACTH test, and current use of PSL at 5 mg/day or less. The association between disease type (PMR vs. RA) and insufficient adrenal response was assessed using logistic regression models. Twenty-six of 34 (76.5%) patients with PMR and 13 of 37 (35.1%) patients with RA had insufficient adrenal response. Compared to patients with RA, patients with PMR were more likely to have insufficient adrenal response, even after adjusting for age, sex, and PSL dose (adjusted odds ratio, 6.75; 95% confidence interval, 1.78-25.60). Patients with PMR have a higher risk of glucocorticoid-induced adrenal insufficiency than patients with RA. Assessing the adrenal function in patients with PMR will contribute to establishing a more appropriate glucocorticoid reduction strategy.