ORAL HYDROCORTISONE THERAPY IN RHEUMATOID ARTHRITIS AN APPRAISAL OF GENERAL RESULTS OF PROLONGED ADNIINISTRATION

Journal/Book: Ann. rheum. Dis. (1955) 14 232.. 1955;

Abstract: Los Angeles California RECEIVED FOR PUBLICATION JUNE 6 1955 Summary The results of prolonged oral hydrocortisone therapy (9 to 36 months) in 150 consecutive patients with active peripheral rheumatoid arthritis were analysed. The following pertinent statistical information was derived: (1) At the time of analysis treatment with the hormone had been discontinued in 24 patients (16 per cent.) for the following reasons: insufficient clinical response in four (2.7 per cent.); major complications in two (1.3 per cent.); complications unrelated to hydrocortisone in one (0.7 per cent.); death from extraneous causes in five (3.3 per cent.); remission in twelve (8. 0 per cent.). (2) Improvement was considered as adequate in 59 per cent. of patients and less than satisfactory in 41 per cent. at the time of analysis. (3) The chief factors which influenced the success of therapy were the severity or activity of the disease and the duration of arthritis before treatment. At analysis improvement was graded as adequate in 36 per cent. with severe disease 57 per cent. with moderately severe disease and 88 per cent. with moderate disease. Results were more favourable when the arthritis was of relatively recent origin; the crucial duration was about 2 years and thereafter as duration lengthened the proportion of adequate response lessened. (4) As time went on fewer patients showed adequate improvement. The disease was restrained satisfactorily in 72 per cent. at 6 months and in 59 per cent. at 19 months. (5) Fifty of the 150 patients (33 per cent.) showed evidence of disease progression during the observation period. Functional capacity was not reduced significantly by advancement of the arthritis in 19 of them but was altered in the remaining 31 patients. The following conclusions were drawn: Although hydrocortisone is a very valuable agent in the management of selected cases of rheumatoid arthritis it is far from an ideal suppressive agent. Like cortisone it has many shortcomings chief among which are the intervention of hormonal side-effects especially when dosage requirements are large; the tendency to aggravate certain co-existing pathological conditions; the development of unresponsiveness in sonic patients after prolonged administration; the failure to prevent disease progression in an appreciable percentage of cases. Thus until a cure for rheumatoid arthritis is found there is still need for an agent which will suppress the disease more successfully. That such a compound may be forthcoming is suggested by recent discoveries of steroids related to hydrocortisone and cortisone which possess wider dissociation the anti-inflammatory properties and the other unwanted physiological activities. ___MH

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