Adrenal response in rheumatoid arthritis treated with long-term steroids

Twenty eight patients who received corticosteroids for rheumatoid arthritis for at least five years were studied. Short synacthen tests were carried out in twenty two of these patients and twelve showed a subnormal response. This response was unrelated to initial or present dose, duration of treatment or activity of disease. Ten patients accepted our offer of steroid reduction. Reduction proved difficult because of patient resistance although the only index of inflammation to worsen was the articular index. We postulate that patient resistance to withdrawal may be due to some factor other than the loss of the anti-inflammatory effect of corticosteroids.