AB0335 Assessment of Adrenal Reserve in Patients with Rheumatoid Arthritis

BackgroundThe hypothalamic-pituitary-adrenal (HPA) axis plays an important role in regulating immune responses. Deficiency in HPA function might contribute to pathogenesis and persistence of rheumatoid arthritis (RA) (1,2). Previous steroid use may also be an important cause for HPA insufficiency as abrupt withdrawal may lead to precipitation of adrenal insufficiency. Therefore, there is a need to assess the functional status of HPA axis to aid the management of patients.ObjectivesTo assess adrenal functions (reserve) in patients with rheumatoid arthritis and to identify the factors associated with it.MethodsLow dose ACTH (1μg) stimulation test was performed for 137 RA patients and blood samples were collected after 30 minutes for cortisol response. Serum cortisol of >18 μg/ml was considered as normal response (3). Presence of adrenal insufficiency was analyzed for possible association with age of onset, sex, duration, previous steroid use, RF, Anti-cyclic citrullinated peptide antibodies (ACPA), VAS, HAQ-Indian and DAS28 using SPSS v.17 software (IBM, India).ResultsThirty one (22.7%) patients were found to have adrenal insufficiency. Patients with adrenal insufficiency had significantly higher (p