New York Academy of Medicine

Abstract

The author reviews the effects of treating 169 cases of chronic rheumatic disease with cortisone and 175 with ACTH (the total so far treated in America). Cortisone and ACTH are effective in the treatment of rheumatoid arthritis, rheumatoid spondylitis, Still's disease, and psoriasis with arthritis. The average dosage for cortisone is 100 mg. daily, in one injection, until a remission is induced, and then 100 mg. thrice weekly. With ACTH it seems preferable to give small doses (generally 25 mg. of standard preparation) four times daily. Relapse after cessation of treatment usually occurs rapidly. Complications include: oedema from sodium retention, hypopotassiumaemia, partial hypercortico-adrenalism, menstrual disorders, diabetic carbohydrate metabolism, insomnia, tachycardia, excitability, and mental depression. They occur more frequently in women, particularly those of premenopausal age, and in children, who require comparatively larger doses. Substances chemically similar to cortisone studied to date, include compound S, progesterone, 1 7-hydroxyprogesterone, pregnenolone, acetoxy-pregnenolone and testosterone, but all are ineffective. In conclusion it is emphasized that, since prolonged administration of cortisone may lead to adrenal atrophy and that of ACTH to pituitary atrophy with adrenal hyperplasia, further research on this problem is required before the hormones can be considered for practical therapy. It remains, however, the greatest advance in the treatment of rheumatic diseases.