SAT0159 Inhibition of Adrenal Axis in Elderly Patients under Treatment with Low Dosis of Corticosteroids: Should We Supplement in Stressful Situations?. (10th June 2014)

• Record Type: Journal Article
• Authors: Martínez-Morillo, M.; Zavala, R.; Granada, M.L.; Riveros-Frutos, A.; Rodríguez-Muguruza, S.; Sanint, J.; Holgado, S.; Olivé, A.; Mateo, L.
• Is Part Of: Annals of the rheumatic diseases. Volume 73:Supplement 2(2014)
• Page Start: 648
• Page End: 648
• Publication Date: 2014-06-10
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2014-eular.4520
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: In some rheumatic diseases low dosis of glucocorticoids (2-5 mg) are used for long periods of time. It is not clear if there is an inhibition of the adrenal axis when one of these patients experiences a stressful situation, such as an illness. This is particularly important in elderly patients, who are most vulnerable to hospitalization. Objectives: Determine whether there is inhibition of adrenal axis in elderly patients under treatment with low dosis of corticosteroids. Methods: Design: prospective. Type of center: University hospital with a referral area of 850, 000 inhabitants. Nineteen patients with inflammatory rheumatic diseases (Elderly Onset Rheumatoid Arthritis and Polymyalgia Rheumatica) were studied: 7 women and 12 men, with a mean age of 77±6.84 years. We underwent stimulation test with synthetic ACTH 1 μg before the onset of oral glucocorticoid treatment and 6 months later. Methylprednisolone was the glucocorticoid used in all patients. The starting mean dose used is these patients was 9.26±2.68 mg, the dose accumulated in 6 months 972.6±248 mg, and the mean daily dose of 5.22±1.0 mg/day. Statistical methods: student t test, ANOVA and ROC curve. Results: A good response was observed in all patients before before the onset of oral glucocorticoids (cortisol at 30 minutes ≥18 mg/dl). After 6 months of treatment the basal cortisol decreased from 18.5±5.9 to 11.95±5.9 (p=0.002) and the stimulated one from 28.96±5.8 to 17.95±5.98 (p<0.001). After 6 months of corticosteroid therapy 10 patients, 52.6%, showed an inadequate response. Patients with an inadequate response had received a higher starting dose of glucocorticoids (8±2.8 versus 10.4±2.0, p=0.048) and also a higher mean daily dose (4.6±1.05 versus 5.7±0.7, p=0.018). Moreover, the accumulated dose and the mean daily dose were inversely correlated with the cortisol response. The ROC curve analysis at 6 months of treatment showed that the best cut off for predicting a poor response was a mean daily dose of 5.16 mg/day, with 70% sensitivity and 88.89% specificity (AUC =0.789, p=0.0065) and that a 100% of patients with insufficient response received a mean daily dose higher than 4.5mg/day. Conclusions: A large percentage of elderly patients treated with low dosis of glucocorticoids showed adrenal axis inhibition after a few months of treatment. Thus, supplementation with higher dosis of glucocorticoids should be recommended to these patients in stressful situations. Acknowledgements: To all the Biochemistry and Reumathology nurses. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.4520