Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study
Authors' conclusion
An impaired adrenal reserve is present in patients with RA.
Study context
- Population
- Patients with moderately/highly active rheumatoid arthritis (RA) starting or escalating treatment; COVID-19 patients and age-matched healthy controls28 RA, 28 COVID-19, 28 HC
- Exposure
- Active RA vs COVID-19 patients vs age-matched healthy controls; within RA, minimal disease activity (MDA) vs non-MDA at 6 months
- Outcome
- Diurnal cortisol production (08-12:00/18:00-22:00) and its value in predicting treatment response (MDA)
- Follow-up
- 6 months
Methodological detailsreal-life, 6-month follow-up, consecutive patients, age-matched healthy controls
- Real-life
- 6-month follow-up
- Consecutive patients
- Age-matched healthy controls
Main finding
As reported in the abstract
Saliva diurnal cortisol production (AUC) · baseline
RA
87.0
± 37.6
COVID-19
146.7
± 14.3
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Values | P value |
|---|---|---|
| Disturbed circadian cortisol rhythm at baseline | RA 15 of 28 · HC 4 of 28 · COVID-19 20 of 28 | |
| Baseline morning cortisol, non-MDA vs MDALower in non-MDA | Non-MDA 10.9 ± 4.0 nmol/L · MDA 18.4 ± 8.2 nmol/L | P = 0.005 |
| Baseline ACTH, non-MDA vs MDAHigher in non-MDA | Non-MDA 4.8 ± 3.3 pmol/L · MDA 2.4 ± 0.4 pmol/L | P = 0.047 |
Treatment-induced MDA achieved · 6 months
- Treatment-induced MDA at 6 months achieved
- 16 of 28
Baseline morning cortisol <13.9 nmol/L predicting non-MDA at 6 months
- Sensitivity
- 75%
- Specificity
- 92%
- P
- P = 0.006
Individualised diurnal cortisol production over time · 3 and 6 months
- Remained largely unchanged from baseline to 3 and 6 months
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study. RMD Open. Published 17 January 2024. doi:10.
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