| アブストラクト | BACKGROUND: Glucocorticoids (GCs) suppress endogenous cortisol levels which can lead to adrenal insufficiency (AI). The frequency of GC-induced AI remains unclear. In this cross-sectional study, low morning salivary cortisol (MSC) levels were used as a measure of adrenal function. The study aim was to investigate the prevalence of low MSC in patients with rheumatoid arthritis (RA) currently and formerly exposed to oral GCs, and the association with potential risk factors. METHODS: Sample collection was nested within UK primary care electronic health records (from the Clinical Practice Research Datalink). Participants were patients with RA with at least one prescription for oral GCs in the past 2 years. Self-reported oral GC use was used to define current use and current dose; prescription data were used to define exposure duration. MSC was determined from saliva samples; 5 nmol/L was the cut-off for low MSC. The prevalence of low MSC was estimated, and logistic regression was used to assess the association with potential risk factors. RESULTS: 66% of 38 current and 11 % of 38 former GC users had low MSC. Among former users with low MSC, the longest time since GC withdrawal was 6 months. Current GC dose, age and RA duration were significantly associated with increased risk of low MSC. CONCLUSION: The prevalence of low MSC among current GC users is high, and MSC levels may remain suppressed for several months after GC withdrawal. Clinicians should therefore consider the risk of suppressed cortisol and remain vigilant for symptoms of AI following GC withdrawal. |
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| 組織名 | Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal;Research, School of Biological Sciences, Manchester Academic Health Science;Centre, The University of Manchester, Manchester, UK.;Division of Diabetes, Endocrinology and Gastroenterology, School of Medical;Sciences, Manchester Academic Health Science Centre, The University of;Manchester, Manchester, UK.;Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester University;NHS Foundation Trust, Manchester, UK.;Health eResearch Centre, Centre for Health Informatics, School of Health;Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology,;Utrecht University, Utrecht, The Netherlands.;Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK.;NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation;Trust, Manchester Academic Health Science Centre, Manchester, UK. |
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