Which patient is most likely to have suppression of the HPA axis and require a slow taper of corticosteroid therapy?

The patient taking 10 mg of prednisone daily for 3 months for rheumatoid arthritis is most likely to experience suppression of the hypothalamic-pituitary-adrenal (HPA) axis and therefore may require a slow taper of corticosteroid therapy. This is attributed to the duration and dosage of corticosteroid use; prolonged exposure to exogenous corticosteroids can lead to adrenal suppression by inhibiting the body’s natural production of corticosteroids.

In this case, the duration of 3 months is significant, as chronic corticosteroid therapy, especially at doses above physiological levels, poses a risk for HPA axis suppression. While 10 mg is not a very high dose, the extended use still warrants caution due to potential adrenal atrophy.

Short-term use of higher doses, as seen in the case of a patient taking 40 mg of prednisone daily for only 7 days, is less likely to result in significant HPA axis suppression. Similarly, the use of mometasone nasal spray is topical and generally does not have systemic effects at conventional doses, thus posing a lower risk for HPA axis suppression. An intraarticular injection of methylprednisolone is also less likely to affect the HPA axis systemically because it delivers the medication directly to