Use Of Systemic Glucocorticoids Research Articles

Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study.

BackgroundLong-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use.MethodsWe randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90), and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures.ResultsHigher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the high-user group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users.ConclusionAs the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.

The efficacy of first-line tyrosine kinase inhibitors combined with co-medications in Asian patients with EGFR mutation non-small cell lung cancer

The real-world efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in patients with advanced non-small cell lung cancer (NSCLC) harboring EGFR-activating mutations remains unclear. We conducted a retrospective cohort study using data from the claims database of Taipei Veterans General Hospital to perform direct comparisons of these three EGFR-TKIs (gefitinib, erlotinib, and afatinib) combined with co-medications (metformin, statins, antacids, and steroids). Stage IIIB and IV NSCLC patients with EGFR mutations receiving EGFR-TKIs as first-line treatment for > 3 months between 2011 and 2016 were enrolled. The primary endpoint was time to treatment failure (TTF). Patients who had received co-medications (≥ 28 defined daily doses) in the first 3 months of EGFR-TKI therapy were assigned to co-medications groups. A total of 853 patients treated with gefitinib (n = 534), erlotinib (n = 220), and afatinib (n = 99) were enrolled. The median duration of TTF was 11.5 months in the gefitinib arm, 11.7 months in the erlotinib arm, and 16.1 months in the afatinib arm (log-rank test, P < 0.001). After adjustments, afatinib showed lower risk of treatment failure compared with gefitinib (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.41–0.71) and erlotinib (HR 0.62, 95% CI 0.46–0.83). The risk of treatment failure in patients treated with EGFR-TKIs who received concomitant systemic glucocorticoid therapy was higher than in those treated with EGFR-TKI monotherapy (HR 1.47, 95% CI 1.08–2.01). Afatinib or erlotinib use was associated with a lower risk of treatment failure in patients with advanced NSCLC harboring EGFR mutations compared to gefitinib use. Concurrent use of systemic glucocorticoids was linked to higher risk of treatment failure.

Information Algorithm for Non-Invasive Evaluation of Osteoresorbable Side Effects of Glucocorticosteroids in Patients with Ulcerative Colitis

A study involving 45 patients with ulcerative colitis found that the activity of the Cathepsin K bone resorption marker measured by an enzyme-linked immunosorbent assay in gingival fluid could be used as a non-invasive control over the development of steroid osteoporosis caused by systemic use of glucocorticoids. When the concentration of Cathepsin K in the gingival fluid exceeded 3.7 pmol/L, the risk of developing osteoporosis in patients with ulcerative colitis taking glucocorticosteroids on a regular basis increased by 7.9 times with a diagnostic accuracy of 82.6% (p=0.002). As a result of the study, an effective method for non-invasive assessment of osteoresorbable side effects of glucocorticosteroids in autoimmune diseases was proposed.

The relationship between cancer and medication exposure in patients with systemic lupus erythematosus: a nested case-control study

BackgroundSystemic lupus erythematosus (SLE) is associated with increased risk of cancer and the mechanism remains unclear. Here, we examined the level of auto-antibodies and disease activity index scores in SLE patients with cancers and analyzed whether medications for SLE management might contribute to the higher cancer risk in SLE patients.MethodsIn this retrospective study, we carried out a nested case-control study in a large cohort of SLE patients. We screened 5858 SLE patients to identify the newly diagnosed and yet to be treated cancers. The following clinical features were evaluated: auto-antibodies levels, SLE disease activity index scores, and previous medication used for SLE management. Systemic glucocorticoid, cyclophosphamide, hydroxychloroquine (HCQ), methotrexate, and azathioprine were considered the main medication indices.ResultsOur analyses identified 51 SLE patients who also had cancer and 204 matched control patients who had SLE but not cancer. Of the 51 SLE patients, thyroid cancer (14/51, 27.45%), cervical cancer (10/51, 19.61%), and lung cancer (7/51, 13.73%) were the most common types. Our analyses did not reveal any significant differences in the levels of auto-antibodies in SLE patients with cancers relative to the control group. Further, we observed that disease activity was significantly lower in SLE patients with cancers relative to the matched control SLE group. There was no statistically significant association between the cancer risk and the use of systemic glucocorticoid, cyclophosphamide, methotrexate, or azathioprine. Importantly, the administration of HCQ was significantly lower in SLE patients suffering cancers relative to the cancer-free matched control group.ConclusionsOur analyses indicate that SLE patients with cancers might have a lower disease activity at the time of cancer diagnosis. HCQ was negatively associated with cancer risk in SLE patients. These findings highlight a potential and novel prevention strategy for SLE.

IMpower110: Clinical safety in a phase III study of atezolizumab (atezo) monotherapy (mono) vs platinum-based chemotherapy (chemo) in first-line non-small cell lung cancer (NSCLC).

e21623 Background: IMpower110 evaluated atezo mono in PD-L1–selected, chemo-naive patients (pts) with nonsquamous (nsq) or squamous (sq) NSCLC. At the interim analysis, IMpower110 met its primary OS endpoint, with a statistically significant and clinically meaningful improvement for atezo vs chemo in TC3 or IC3 wild-type ( EGFR/ALK-negative) pts. We report on the safety profile of atezo vs chemo in IMpower110. Methods: 572 pts with stage IV nsq or sq NSCLC, PD-L1 expression ≥ 1% on TC or IC and ECOG PS 0-1 were randomized 1:1 to receive atezo (1200 mg IV q3w) or chemo (4 or 6 21-day cycles). In the chemo arm, nsq pts received cisplatin (cis) 75 mg/m2 or carboplatin (carbo) AUC 6 + pemetrexed (pem) 500 mg/m2 IV q3w; sq pts received cis 75 mg/m2 + gemcitabine (gem) 1250 mg/m2 or carbo AUC 5 + gem 1000 mg/m2 IV q3w. Safety was assessed in all treated pts (safety evaluable [SE] population [pop]), regardless of PD-L1 expression or EGFR/ALK status. AEs were summarized per MedDRA v22.0 and severity graded per NCI CTCAE v4.0. Immune-mediated AEs (imAEs) were defined per a sponsor-specified list of terms, regardless of whether the events led to systemic glucocorticoid, endocrine therapy, or other immunosuppressants use. Results: At data cutoff (Sep 10, 2018) within the ITT pop, treatment (tx) was ongoing in 90 (atezo: 31.6%) and 25 (chemo: 8.7%) pts, with 13.7 mo of follow-up. Within the SE pop (atezo: n = 286, chemo: n = 263), atezo pts had longer tx exposure (5.3 mo) vs chemo pts (pem, 3.5 mo; gem, 2.6 mo; carbo, 2.3 mo; cis, 2.1 mo). Atezo had a favorable safety profile vs chemo (table); safety data were consistent with data from a pooled atezo mono pop. imAEs occurred in 40.2% (atezo) and 16.7% (chemo) of pts and were Grade (Gr) 3-4 in 6.6% and 1.5%, respectively. Conclusions: Atezo was better tolerated than chemo and imAEs were generally low grade. Overall, the safety experience with atezo mono in IMpower110 was consistent with its known safety profile; no new safety signals were identified. Clinical trial information: NCT02409342. [Table: see text]

Effectiveness and safety of glucocorticoids to treat COVID-19: a rapid review and meta-analysis.

BackgroundGlucocorticoids are widely used in the treatment of various pulmonary inflammatory diseases, but they are also often accompanied by significant adverse reactions. Published guidelines point out that low dose and short duration systemic glucocorticoid therapy may be considered for patients with rapidly progressing coronavirus disease 2019 (COVID-19) while the evidence is still limited.MethodsWe comprehensively searched electronic databases and supplemented the screening by conducting a manual search. We included randomized controlled trials (RCTs) and cohort studies evaluating the effectiveness and safety of glucocorticoids in children and adults with COVID-19, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and conducted meta-analyses of the main indicators that were identified in the studies.ResultsOur search retrieved 23 studies, including one RCT and 22 cohort studies, with a total of 13,815 patients. In adults with COVID-19, the use of systemic glucocorticoid did not reduce mortality [risk ratio (RR) =2.00, 95% confidence interval (CI): 0.69 to 5.75, I2=90.9%] or the duration of lung inflammation [weighted mean difference (WMD) =−1 days, 95% CI: −2.91 to 0.91], while a significant reduction was found in the duration of fever (WMD =−3.23 days, 95% CI: −3.56 to −2.90). In patients with SARS, glucocorticoids also did not reduce the mortality (RR =1.52, 95% CI: 0.89 to 2.60, I2=84.6%), duration of fever (WMD =0.82 days, 95% CI: −2.88 to 4.52, I2=97.9%) or duration of lung inflammation absorption (WMD =0.95 days, 95% CI: −7.57 to 9.48, I2=94.6%). The use of systemic glucocorticoid therapy prolonged the duration of hospital stay in all patients (COVID-19, SARS and MERS).ConclusionsGlucocorticoid therapy was found to reduce the duration of fever, but not mortality, duration of hospitalization or lung inflammation absorption. Long-term use of high-dose glucocorticoids increased the risk of adverse reactions such as coinfections, so routine use of systemic glucocorticoids for patients with COVID-19 cannot be recommend.

The impact of glucocorticoid medication use on hair cortisol and cortisone in older adults: Data from the Irish Longitudinal Study on Ageing

Research focusing on the hair concentration of cortisol and cortisone has significantly developed over the last two decades and has huge potential to provide relevant insights into stress-related diseases. However it is not clearly understood exactly how glucocorticoid (GC) medications, which are commonly prescribed drugs particularly among older adults, may affect hair cortisol and cortisone levels. The aim of this study was to examine associations of the use of GC medications with hair cortisol and cortisone concentrations in a sample of older adults. Hair samples and data were collected from participants at Wave 3 of The Irish Longitudinal Study of Ageing (TILDA). Results showed that before and after controlling for socio-demographic, health and hair characteristics, the use of systemic GCs was associated with decreased hair cortisone (B= -0.34 95 % CI -0.53, -0.16, p < 0.001). However, the use of local GCs was associated with increased hair cortisol (B = 0.39 95 % CI 0.18, 0.61). Further analysis suggests that the latter finding may be the result of use of topical steroid creams/ointments. These data add to the scant literature on the impact of steroid medication use on hair cortisol and cortisone in non-clinical populations, providing further evidence that future hair GC studies need to consider steroid medication use.

Meta-analysis of the Clinical Efficacy and Safety of High- and Low-dose Methylprednisolone in the Treatment of Children With Severe Mycoplasma Pneumoniae Pneumonia.

Mycoplasma pneumoniae pneumonia is generally a self-limiting disease, but it can develop into severe Mycoplasma pneumoniae pneumonia (SMPP). Immunologic mechanisms are thought to play an important role in the pathogenesis of SMPP. Therefore, the use of systemic glucocorticoids may have beneficial effects. However, to date, the use of glucocorticoid therapy in SMPP is limited to small case series, and the glucocorticoid dosage for children with SMPP has not been established. Here, we used a meta-analysis method to collect data from randomized control trials of different doses of methylprednisolone in SMPP to assess the safety and efficacy of treatment with low- versus high-dose methylprednisolone in children with SMPP. We included 13 Chinese randomized control trials that included 1049 children. The high- and low-dose groups were comprised of 524 and 525 children, respectively. The high-dose group was significantly more effective than the low-dose group in clinical efficacy [risk ratio = 1.30, 95% confidence interval (CI) (1.23, 1.38), P < 0.05]. In addition, compared with low-dose methylprednisolone, high-dose methylprednisolone significantly shortened hospital stays and antipyretic therapy, pulmonary rales disappearance, cough disappearance and pulmonary shadow absorption times. There was no significant difference in adverse events between the high- and low-dose groups: risk ratio= 0.85, 95% CI (0.53, 1.36), P > 0.05. We conclude that high-dose methylprednisolone is effective in the treatment of SMPP without increasing the incidence of adverse reactions.

Therapeutic glucocorticoids: mechanisms of actions in rheumatic diseases.

Therapeutic glucocorticoids have been widely used in rheumatic diseases since they became available over 60 years ago. Despite the advent of more specific biologic therapies, anotable proportion of individuals with chronic rheumatic diseases continue to be treated with these drugs. Glucocorticoids are powerful, broad-spectrum anti-inflammatory agents, but their use is complicated by an equally broad range of adverse effects. The specific cellular mechanisms by which glucocorticoids have their therapeutic action have been difficult to identify, and attempts to develop more selective drugs on the basis of the action of glucocorticoids have proven difficult. The actions of glucocorticoids seem to be highly cell-type and context dependent. Despite emerging data on the effect of tissue-specific manipulation of glucocorticoid receptors in mouse models of inflammation, the cell types and intracellular targets of glucocorticoids in rheumatic diseases have not been fully identified. Although showing some signs of decline, the use of systemic glucocorticoids in rheumatology is likely to continue to be widespread, and careful consideration is required by rheumatologists to balance the beneficial effects and deleterious effects of these agents.

Budesonide treatment for microscopic colitis from immune checkpoint inhibitors

BackgroundImmune checkpoint inhibitors (CPIs) are effective against a variety of malignancies but can be limited by inflammatory toxicities such as enterocolitis. Enterocolitis is typically treated with systemically active glucocorticoids. Endoscopy can stratify patients by the severity of mucosal inflammation, including identifying patients with colitis in the absence of visible mucosal changes: microscopic colitis. Whether patients with CPI microscopic colitis could be managed differently from colitis with more severe mucosal involvement is unclear. The objective of this study was to describe outcomes in CPI microscopic colitis focusing on the response to first line treatment with budesonide.MethodsWe evaluated data from a retrospective cohort from a single-center large academic hospital. The participants were all adult patients evaluated by endoscopy for suspected CPI enterocolitis between 3/2017 and 3/2019. The exposures were: Mayo Endoscopic Score (range 0–3). The subset was: oral budesonide, maximum dose 12 mg daily, administered minimum of 5 weeks. The main outcomes and measures were: Primary: time from first CPI exposure to first glucocorticoid use; use of systemic glucocorticoids; time from symptom onset to resolution; continuation of CPI therapy; number of additional CPI infusions received. Secondary: admissions for symptom control; novel irAE development; need for second-line immunosuppression; oncologic outcomes.ResultsWe identified 38 patients with biopsy confirmed CPI enterocolitis, 13 in the microscopic colitis cohort, and 25 in the non-microscopic colitis cohort. Budesonide use was higher in the microscopic colitis cohort (12/13 vs 3/25, p < 0.001), and systemic glucocorticoid use was higher in non-microscopic colitis (22/25 vs. 3/13, p < 0.001). Time from symptom onset to resolution did not differ. Microscopic colitis patients more frequently remained on CPI after developing (entero)colitis (76.9% vs 16.0%, p < 0.001). Microscopic colitis patients tolerating further CPI received, on average, 4.2 CPI infusions more than non-microscopic colitis patients tolerating CPI (5.8 vs 1.6, p = 0.03). Microscopic colitis was associated with increased time-to-treatment-failure (HR 0.30, 95% CI 0.14–0.66) and progression-free survival (HR 0.22, 95% CI 0.07–0.70).ConclusionsGastrointestinal mucosal inflammation without visible mucosal injury is a distinct, prevalent CPI enterocolitis subset that can be diagnosed by endoscopy. First-line budesonide appears effective in controlling “microscopic colitis” symptoms and prolonging immunotherapy duration. These findings present a compelling rationale for routine endoscopic evaluation of suspected CPI enterocolitis and suggest an alternative glucocorticoid-sparing treatment strategy for a subset of such patients.

Effectiveness of Xin Jia Xuan Bai Cheng Qi Decoction in treating acute exacerbation of chronic obstructive pulmonary disease: study protocol for a multicentre, randomised, controlled trial

IntroductionAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) brings a serious impact on patients’ quality of life, and has extremely high morbidity and mortality worldwide. Although there are many therapies...

DEX-2-TKA-DEXamethasone twice for pain treatment after Total Knee Arthroplasty: A protocol for a randomized, blinded, three-group multicentre clinical trial.

Multimodal analgesia is considered the leading principle for post-operative pain treatment, but no gold standard after total knee arthroplasty (TKA) exists. To investigate the beneficial and harmful effects of one or two doses of 24mg intravenous dexamethasone (DXM) as part of a multimodal analgesic regimen (paracetamol, NSAID and perioperative local infiltration analgesia) after TKA. We hypothesize that addition of DXM will reduce post-operative opioid consumption. DEXamethasone twice for pain treatment after TKA is a randomized, blinded, three-group multicentre clinical trial. Participants will be randomized to one of three groups: placebo, single dose of DXM or two consecutive doses of DXM. Participants, treatment providers and investigators will be blinded to the allocated intervention. The primary outcome is total opioid consumption (units of morphine equivalents) 0-48hours post-operatively. unilateral, primary TKA; age ≥18years; American Society of Anesthesiologists-Score 1-3; Body Mass Index ≥18 and ≤40; for women-not pregnant; and written informed consent. allergy or contraindications against trial medication; daily use of high dose opioid and/or use of methadone/transdermal opioids; daily use of systemic glucocorticoids; dysregulated diabetes; and patients suffering from alcohol and/or drug abuse. Four-hundred-and-eighty-six eligible participants are needed to detect or discard a difference of 10mg morphine equivalents 0-48hours post-operatively maintaining a familywise error rate of 0.05 and a power of 90% for the three possible pairwise comparisons. Recruiting is planned to commence September 2018 and expected to finish March 2020. EudraCT: 2018-001099-39 (08/06-18); ClinicalTrials.gov: NCT03506789 (24/04-2019). Editorial Comment This is the protocol for the largest randomized clinical trial investigating the effect of one or two doses of dexamethasones on pain treatment after total knee arthroplasty. Due to the pragmatic and rigerous design this study will deliver results of high quality and external validity.

Fifteen-year nationwide trends in systemic glucocorticoid drug use in Denmark.

Glucocorticoid treatment of inflammatory disorders is associated with significant adverse effects related to glucocorticoid excess as well as adrenal insufficiency. This necessitates awareness of its use. We therefore investigated trends in systemic glucocorticoid use as well as morbidity and comedications among users. Cross-sectional drug utilisation study. We conducted a population-based study of 926,314 users of systemic glucocorticoids (oral and injectable formulations) from 1999 to 2014 using Danish nationwide registries. We computed annual prevalence and incidence of systemic glucocorticoid use and prevalence of comedications and morbidity. Further, we assessed the annual amount of disease-modifying drug use. Of the 926,314 users of systemic glucocorticoids, 54% were female and median age at first-time use was 55 years. The annual prevalence was ≈ 3%, while the incidence was ≈ 1.4/100 person years (p-y). Both figures remained constant from 1999 to 2014. In the elderly, the annual prevalence was 6.7-7.7% (60-79 years of age) and 9.7-11% (≥80 years of age). Incidence increased among persons aged ≥80 years from 3.0/100 p-y in 1999 to 3.6/100 p-y in 2014. Concomitantly, the annual amount of for example methotrexate, azathioprine and tumour necrosis factor (TNF)-alpha agents increased and new biological agents emerged. The most frequent comedications were antibiotics (49%), cardiovascular drugs (38%) and NSAIDs (37%). Our findings confirm a widespread use of systemic glucocorticoids, especially in the elderly, which prevails despite increased use of disease-modifying drugs. The continuously prevalent use of glucocorticoid use constitutes a challenge for the endocrine community.

An underestimated comorbidity of COPD: Thyroid dysfunction.

Chronic obstructive pulmonary disease (COPD) has many systemic effects influencing morbidity and mortality of the disease. Thyroid diseases which are more common in COPD patients than who do not have COPD are underestimated despite important clinical consequences. Similar to general population, thyroid dysfunctions are more common in females than males among COPD patients. Both hypothyroidism and hyperthyroidism may be associated to COPD. As well as systemic inflammation hypoxia, age, glucocorticoid use and smoking are some of the effective factors on developing thyroid dysfunction in COPD patients. In this article thyroid dysfunctions that are underrecognized comorbidities of COPD patients, their mechanisms of action and clinical outcomes were reviewed.

Neumonitis por docetaxel, discusión de un caso

&#x0D; &#x0D; &#x0D; La neumonitis intersticial por docetaxel es un evento infrecuente, pero con alto potencial de mortalidad y puede ser potencialmente reversible con el uso de esteroides sistémicos; se considera importante en el diagnóstico diferencial del paciente bajo quimioterapia con síntomas respiratorios. A continuación, se presenta un caso de neumonitis fatal por docetaxel en un paciente con carcinoma de próstata avanzado. Paciente de 80 años de edad con historia de cáncer de próstata de 15 años de evolución, en progresión ósea y ganglionar, y que inició manejo con docetaxel. Después de la aplicación del tercer ciclo presenta disnea de esfuerzos, fiebre, tos seca y deterioro general. Se realizó diagnóstico de neumonitis por docetaxel y se descartaron otras entidades. La neumonitis intersticial por docetaxel es una entidad rara. Los pilares del tratamiento son la suspensión del medicamento, el soporte ventilatorio y el uso de glucocorticoides sistémicos.&#x0D; &#x0D; &#x0D;

Osteoporosis Pathophysiology, Epidemiology, and Screening in Rheumatoid Arthritis

To review the burden of osteoporosis (OP) in rheumatoid arthritis (RA) and to describe the OP screening strategies applied in RA. RA is an inflammatory condition that predisposes patients to development of OP. OP in RA has a multifactorial pathogenesis with systemic inflammation and glucocorticoid use playing major roles. Newer studies have reported an intriguing association between RA autoantibodies and the development of OP. OP screening strategies in RA patients include clinical and vitamin D assessment, biochemical markers of bone remodeling, and bone imaging evaluations, particularly dual-energy X-ray absorptiometry (DXA). Fragility fractures are an important comorbidity of RA. OP screening strategies are both feasible and effective in RA patients and recommended by most specialty organizations. Given the considerable exposure to factors related to OP development, such as pro-inflammatory cytokines and glucocorticoid treatment, special attention should be directed to biochemical and DXA results in RA patients.

Focus on the standardization of diagnosis and treatment of fungal endophthalmitis

Fungal endophthalmitis is a kind of severe ocular infectious disease with poor prognosis.The damage degree of fungal endophthalmitis to ocular tissues is due to the fungi's destructivity, delayed diagnosis and non-standardized therapy.Early and proper intervention is crucial for saving visual function.There are different features of risk factors, pathogens and clinical presentations in exogenous infection and endogenous infection.Different key points of theraputic approaches should be identified to achieve early diagnosis and effective treatment, such as reasonably selecting the right type of antifungal drugs, different ways of administration, appropriate drug dose or surgical method.In the treatment of fungal endophthalmitis, the application of glucocorticoid is controversial, and the use of local or systemic glucocorticoid should be avoided as far as possible. Key words: Fungal endophthalmitis; Clinical features; Diagnostic approaches; Anti-fungus drugs

SUN-LB048 Takayasu Arteritis in a Young Woman with Type 1 Diabetes

Takayasu arteritis (TAK) is a rare, chronic large-vessel vasculitis affecting primarily the aorta and its branches. It is uncommon in children and non-Asian ethnic groups. Co-incidence of TAK and type 1 diabetes (T1DM) is rare. We present a case of a 19-year-old Hispanic woman with longstanding T1DM and autoimmune thyroiditis who was diagnosed with TAK. She presented with T1DM and subclinical autoimmune thyroiditis at age 9. She was poorly adherent to diabetes care plan and admitted multiple times for DKA due to insulin omission. HbA1C average over 10 yrs was approximately 11%. At age 18 she presented to an outside hospital with severe abdominal pain and was diagnosed with appendicitis. Appendectomy was complicated by identification of an ischemic segment of small bowel, which was resected, and also for finding a thrombosis in the superior mesenteric artery (SMA). The SMA thrombosis was initially felt to be related to the prothrombotic state of poorly controlled DM1; she had a high atypical p-ANCA titer but erythrocyte sedimentation rate (ESR) had been normal. Her clinical course was complicated by severe cachexia resulting in multiple readmissions to address chronic abdominal complaints, malnutrition and diarrhea. She was also admitted for an episode of pyelonephritis during which she developed severe liver dysfunction of unclear cause. Diabetes remained poorly controlled. At age 19 she was admitted for DKA and weight loss. An abdominal bruit was identified on exam. There was no hypertension. Labs demonstrated a significant elevation of ESR of 101 mm/hr. A diagnostic evaluation was initiated. Imaging (CT and MR angiography) revealed chronic occlusion of the proximal SMA as well as vasculitis of the infrarenal aorta and inferior mesenteric artery. Conventional angiogram did not show vasculitis distal to the origin of the aortic vessels. Based on the constellation of findings including constitutional and gastrointestinal symptoms, the arterial bruit on exam, the high ESR, and findings on imaging, a diagnosis of large-vessel vasculitis (TAK) was made. She was treated with azathioprine and a taper of oral prednisone. Weight increased and ESR decreased initially down to 20 mm/hr, but ESR again increased (up to 40 mm/hr) with imaging evidence of ongoing vasculitis when steroids were weaned. This case adds to the sparse literature describing the association between TAK and T1DM. It highlights that TAK may occur in very young adults of non-Asian descent. It also showcases the difficulty in diagnosis of TAK, which may have a subacute and nonspecific presentation, in an individual with poorly controlled DM1 as well as SMA thrombosis, which has been described as an acute complication of DKA in case reports. The use of systemic glucocorticoids as a mainstay of TAK therapy may present additional challenges in an individual with DM1. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Use of systemic glucocorticoids in patients with psoriatic arthritis by Argentinian and other Latin-American rheumatologists.

To analyse the administration of systemic glucocorticoids (SGC) to patients with Psoriatic arthritis (PsA). Online, anonymous, multiple-choice, closed-ended survey on SGC use in PsA, dose, duration of therapy, and the reason for administration. One hundred and twenty rheumatologists from Argentina (ARG) and 75 from other countries in Latin-America (LAT) completed the survey. Only 6% of the respondents indicated that they did not prescribe SGC, and 65% claimed that they administered them to less than 10% of their patients. Among those physicians who used SGC, 71% prescribed between 5 and 10mg/day of prednisone, and only 5% over 10mg/day. Seventy-three percent of the respondents administered SGC for less than 3 months, and 93% associated them with DMARDs, Biological Therapy (BT), or DMARDs plus BT. Clinical indications for SGC were (more than one option was possible): peripheral arthritis (79%), dactylitis (23%), enthesitis (20%), cutaneous involvement (11%), and axial involvement (8%). Thirty-four percent of ARG physicians versus 21% of LAT used SGC in over 10% of their patients (p 0.07) while 76.5% of ARG versus 59% of LAT administered doses higher than 5mg/day of prednisone (p 0.01). SGC were indicated by most of the rheumatologists surveyed, but only to a reduced number of patients with PsA, at low doses, for short periods of time, associated with DMARDs/BT, and with the aim of treating peripheral joint manifestations. Argentinian physicians tended to prescribe SGC to more patients and at slightly higher doses.

Hepatitis B virus reactivation induced by glucocorticoids: an important issue requiring urgent attention in dermatology

There is a high incidence of hepatitis B virus (HBV) infection in China, and dermatologists often encounter patients with skin diseases complicated by HBV infection in clinic. With the widespread use of systemic glucocorticoids in dermatology, HBV reactivation has become a constant problem to face in the treatment process. Attention should be given to risk factors of HBV reactivation, including HBV DNA replication, positive hepatitis B surface antigens (HBsAg) and positive hepatitis B core antibodies (HBcAb) . According to HBV serological markers, risk stratification of HBV reactivation induced by glucocorticoids needs to be grasped, and treatment measures should be taken timely to prevent HBV reactivation. In this way, liver function impairment induced by HBV reactivation during the course of glucocorticoid therapy may be avoided to the greatest extent, which is of great benefit to clinical work. Key words: Glucocorticoids; Hepatitis B virus; Hepatitis B; Virus activation