Adrenocortical Function in Children with Juvenile Rheumatoid Arthritis and Other Connective Tissue Disorders

Abstract

The adrenocortical function in 121 patients with juvenile rheumatoid arthritis (JRA) or other connective tissue diseases was investigated by determination of the circadian change in plasmacortisol and by an ACTH test. Eighty-eight children without rheumatoid arthritis, hospitalized for other diseases or under observation, acted as controls. Thirty-one patients with JRA but not receiving oral or intra-articular corticosteroid treatment had normal plasmacortisol values and normal results in ACTH tests. Nineteen patients with daily oral Prednisolone treatment demonstrated a weak circadian change and insufficient response in the adrenocortical function test. Patients receiving oral Prednisolone on three successive days per week or alternate-day oral corticosteroid therapy had some depression of their adrenocortical function, which was, however, significantly less than for patients on continuous oral corticosteroid treatment. Intraarticular corticosteroid treatment showed a depression in the circadian plasmacortisol change, which was also reflected in the low starting level in the adrenocortical function test. This depression was most obvious during the first 7 days after intra-articular injection, but even 4 weeks after the injection the basal plasmacortisol levels at 2 a.m. were lower than in the controls. The ACTH test is in most cases sufficient for the investigation of the adrenocortical function and is preferred instead of the determination of the circadian plasmacortisol change in children.