Endocrine Abstracts

Introduction

Corticosteroids play an essential role in the management of many rheumatic diseases. However, corticosteroids are associated with many adverse effects, including hyperglycaemia, dyslipidaemia, and osteoporosis. These adverse effects are dose related and patients on high dose, long term steroids (defined as > 5 mg oral prednisolone and treatment duration > 3 weeks) are at greatest risk. NICE guidelines on corticosteroids recommend monitoring of HbA1c, triglycerides, and potassium for all patients on long term steroids1. Regarding osteoporosis risk, it is recommended that all adults who are expected to be on prednisolone ≥ 5 mg/day (or equivalent) for over 3 months have bone mineral density assessed three-yearly².

Aims

To examine whether Hba1C, potassium, and lipid profile are monitored amongst rheumatological patients on steroids, and to assess whether these patients have had bone mineral density assessed within the previous 3 years by means of dual energy X-ray absorptiometry (DEXA).

Materials and methods

This retrospective audit examined the records of 442 patients attending rheumatology clinics in Mater Misericordiae University Hospital, Dublin, Ireland over a 4-week period in November 2020.

Methods and results

Fourteen percent (n = 62) of patients were on high dose long term steroids. Seventy-one percent (n = 44) were female, 29% male (n = 18), with a median age of 63 years. The most common conditions encountered were rheumatoid arthritis (22% n = 14), giant cell arteritis (21% n = 13), polymyalgia rheumatica (18%, n = 11), systemic lupus erythematous (6% n = 4), large vessel vasculitis (5% n = 3), mixed connective tissue disease (5% n = 3) Bechet’s (5% n = 3) and others (18% n = 11). All patients were on prednisolone and the mean dose was 8.7 mg. The median duration of treatment was 24 months. Ninety seven percent of patients (n = 60) had potassium checked within the preceding 12 months. Fifty percent (n = 31) had triglycerides checked, 52% (n = 32) had Hba1C checked. The average Hba1C level was 42.4 mmol/mol. Forty three percent (n = 14) had Hba1c in the range of 42–47, while 16% (n = 5) had a Hba1c ≥ 48. The majority of patients (69%, n = 43) had undergone DEXA scanning, with an average recorded T score of –1.47.

Conclusions

Corticosteroids have a significant role to play in the management of many rheumatic conditions. Prescribers need to be aware of the many associated adverse effects and monitor for the presence of these effects accordingly. 1. NICE guidelines: Corticosteroids. June 2020; 2. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Liu et al. Allergy, Asthma & Clinical Immunology 2013.