Background/Purpose: Prednisone is a glucocorticoid (GC) medication commonly used in moderate ( >7.5 mg per day) to high doses (≥ 1 mg/kg/day) for children with moderate to severe presentations of rheumatic disease. Adverse effects (AE) to GCs impose a significant burden on health and quality of life. We sought to evaluate a possible relationship between baseline patient body-mass-index (BMI) measure and development of select GC-mediated toxicity within the first 12 months of prednisone therapy. Secondary outcomes were to examine rates of GC-mediated hypertension, osteopenia, and osteoporosis.

Methods: We performed a retrospective chart review on children with rheumatic disease age 17 years and younger treated with moderate and high-dose prednisone therapy at a single Canadian academic hospital between January 1, 2010 and December 31, 2019. Demographic variables collected included diagnosis, age, sex, ethnicity. Clinical variables collected include weight, height, and body-mass-index (BMI), hepatitis (transaminases greater than two-fold upper normal limit), proteinuria ( >0.1 g/L), and presence of hypoalbuminemia ( < 38g/L) at baseline. We collected weight, height, and body-mass-index (BMI), at 6 and 12 months, the maximum BMI, and transformed them to z-scores according to the World Health Organization's Child Growth standards. Cumulative prednisone dose (mg/kg/12 months), total days on prednisone in the first 12 months of therapy were also obtained, in addition to bone-mineral-density scores after 12 months of prednisone therapy where available.

Baseline characteristics which were significant for the subsequent development of obesity during the first 12 months at the bivariate level (p < 0.05) were included as predictors of obesity in separate logistic regression analyses. In each regression analysis, we also adjusted for baseline BMI, and for confounding variables of hepatitis, hypoalbuminemia (albumin less than 38 grams per litre), proteinuria and prednisone dose. All analyses were performed using SPSS v.26 (IBM Corp., Armonk, NY, USA), and p-values < 0.05 were considered statistically significant.

Results: Seventy-six charts were reviewed, and 73 patients met criteria for analysis. The diagnoses included 20 (26.3%) systemic JIA, 12 (15.8%) JIA, 24 (31.6%) SLE, and 8 (10.5%) JDM patients. Rates of adverse effects were as follows: obesity 27.6%, hypertension 34.2%, symptomatic vertebral fractures 2.2%, long-bone fractures 6.8%. Of 25 patients who had bone mineral density studies, 3 (12%) met criteria for pediatric osteoporosis. Greater BMI at baseline was associated with greater total weight gain (OR 3.358, 95% CI = [1.847-6.103, p< 0.001). Normal albumin ( > 38 g/L was negatively associated with GC-related obesity (OR 0.349, 95% CI [0.132-0.921], p=0.035).

Conclusion: Greater baseline patient BMI was a predictor of GC-related obesity initiated with moderate to high-dose prednisone therapy in children with rheumatic disease. Further work is required to determine methods for individualized prednisone dosing and counseling and behavioral interventions to mitigate risk for weight gain.

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/baseline-body-mass-index-and-risk-for-obesity-in-children-with-rheumatic-disease-on-moderate-to-high-dose-prednisone-therapy/