The effect of therapeutic glucocorticoids on the adrenal response in a randomized controlled trial in patients with rheumatoid arthritis

Arthritis and Rheumatism
J R KirwanF Wollheim

Abstract

To measure the effect of low-dose systemic glucocorticoid treatment on the adrenal response to adrenocorticotropic hormone (ACTH) in patients with rheumatoid arthritis (RA). Patients with RA who took part in a randomized double-blind placebo-controlled trial of budesonide (3 mg/day and 9 mg/day) and prednisolone (7.5 mg/day) underwent a short (60-minute) test with injection of ACTH (tetracosactide hexaacetate) at baseline and the day after completing the 3-month treatment program. Plasma cortisol measurements at baseline and 3 months were compared within and between the treatment groups. Individual patients were classified as normal responders to ACTH or as abnormal responders if changes were >2 SD below the pretreatment value in the entire group of study patients. Short tests with ACTH injection were performed on 139 patients before beginning the study medication and on 134 patients after cessation of the medication. There were no changes in the placebo group. Mean plasma cortisol levels following treatment were reduced in all active treatment groups. In addition, mean values were significantly reduced for the 30-minute and 60-minute responses to ACTH. The maximum reduction (35%) occurred in the prednisolone group at 60 minute...Continue Reading

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Citations

Nov 16, 2011·Nature Reviews. Rheumatology·Bharath M Akkara Veetil, Tim Bongartz
Apr 15, 2011·Rheumatology·Jos N HoesJohannes W J Bijlsma
Jan 23, 2015·Arthritis Research & Therapy·Cornelia M SpiesFrank Buttgereit
May 27, 2014·Expert Opinion on Pharmacotherapy·Rolf Rau
Apr 24, 2016·Seminars in Arthritis and Rheumatism·Rebecca M JosephWilliam G Dixon
Jul 24, 2010·Acta Paediatrica·Benedikt M HuberChrista E Flück
Apr 24, 2015·Current Rheumatology Reports·Emma HarrisSarah Louise Mackie
Sep 29, 2009·European Journal of Internal Medicine·Claire BracewellClive Kelly
Jul 19, 2014·World Journal of Orthopedics·Megan L Krause, Eric L Matteson
Sep 8, 2017·European Journal of Endocrinology·Stina Willemoes BorresenUlla Feldt-Rasmussen
Oct 3, 2013·The Journal of Rheumatology·Elizabeth R VolkmannDaniel E Furst
Apr 7, 2015·The Journal of Clinical Endocrinology and Metabolism·Leonie H A BroersenOlaf M Dekkers
Jul 22, 2004·The Cochrane Database of Systematic Reviews·P C Gotzsche, H K Johansen
Jun 8, 2021·European Journal of Clinical Investigation·Maria G FilippaMaria P Yavropoulou
Jul 14, 2021·BMJ : British Medical Journal·Alessandro Prete, Irina Bancos

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