Adrenal insufficiency in Patients with Rheumatoid Arthritis: Prevalence, Clinical Implications, and Management Strategies

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune-inflammatory disease that affects a significant proportion of the global population. It is characterized by synovial inflammation and joint destruction, leading to disability. The treatment of RA often involves the use of glucocorticoids, which can result in adrenal insufficiency (AI) due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis. The prevalence of AI in RA patients varies but is generally higher compared to the general population. The diagnosis of AI can be challenging due to its nonspecific symptoms and overlap with RA manifestations. Delayed recognition and inadequate management of AI can lead to adrenal crises, which are life-threatening emergencies. Regular monitoring of adrenal function, glucocorticoid replacement therapy, optimization of RA treatment, and patient education are crucial in the management of AI in RA patients. Future research should focus on risk stratification, the development of novel biomarkers, the exploration of alternative treatment strategies, and the evaluation of long-term outcomes to enhance our understanding and improve the management of AI in RA patients.