Prolonged Uninterrupted Cortisone Therapy in Rheumatoid Arthritis

Abstract 1. Detailed hematologic observations, bone marrow aspirations and blood volume determinations were made on 20 patients with rheumatoid arthritis and allied disorders before, during and after the administration of either ACTH or cortisone. 2. Significant reticulocytosis occurred in every patient during therapy, but its magnitude was poorly correlated with either the initial degree of anemia or subsequent increase in circulating red cell mass. 3. There was an increase in hematocrit and total circulating red cell mass of all anemic patients who responded clinically to either ACTH or cortisone. There was little or no improvement of anemia when the clinical response was poor. 4. Polycythemia did not occur in any patient during prolonged therapy or with repeated courses of either ACTH or cortisone. 5. Hemodilution and hemoconcentration were much more profound during and after ACTH administration than they were with cortisone. 6. Bone marrow studies revealed moderate depression of the erythroid series before treatment. At the end of therapy erythroid elements were normal. 7. Significant polymorphonuclear leukocytosis occurred its all patients during therapy while lymphopenia was inconstant and unsustained. Circulating eosinophils were depressed more with ACTH than with cortisone treatment. 8. Before treatment eosinophils and their precursors were present in the bone marrow its normal or increased numbers. During therapy the number of these cells was unchanged in the marrow, even when there was profound peripheral eosinopenia 9. The role of ACTH and cortisone in the physiologic mechanism of hematopoiesis is discussed. 10. The improvement in the anemia associated with inflammatory disease in response to ACTH or cortisone therapy probably is a reflection of the control of the underlying disease rather than a primary "stimulation" of the bone marrow.

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Clinical Evaluation of Prolonged ACTH and Cortisone Therapy in 114 Cases of Rheumatoid Arthritis: A 3 1/2-year Study

Scandinavian Journal of Rheumatology ◽

10.3109/03009745509164865 ◽

1972 ◽

Vol 1 (1) ◽

pp. 243-249 ◽

Cited By ~ 2

Author(s):

Jan H. Solem ◽

Olaf Römcke

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Evaluation ◽

Cortisone Therapy

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TRIAMCINOLONE THERAPY IN THE ADRENOGENITAL SYNDROME

PEDIATRICS ◽

10.1542/peds.27.2.292 ◽

1961 ◽

Vol 27 (2) ◽

pp. 292-299

Author(s):

Orville C. Green ◽

William W. Cleveland ◽

Lawson Wilkins

Keyword(s):

Rheumatoid Arthritis ◽

Nephrotic Syndrome ◽

Side Effects ◽

Lupus Erythematosus ◽

Adrenal Hyperplasia ◽

Adrenogenital Syndrome ◽

Margin Of Safety ◽

Cortisone Therapy

Triamcinolone has the unique advantage that it is not a salt-retaining steroid, and therefore it has been found useful to physicians dealing with pharmacologic doses in serious diseases such as rheumatoid arthritis, lupus erythematosus, and the nephrotic syndrome. In the physiologic dosage ranges utilized in the adrenogenital syndrome, salt retention and other side effects are not complications of cortisone therapy. Our results would indicate that triamcinolone is 8 to 10 times as potent as cortisone when comparing adrenal suppressive ability. However, the increased potency of this compound is accompanied by a reduced margin of safety, and cortisone, hydrocortisone, or prednisone remain the drugs of choice in treatment of congenital virilizing adrenal hyperplasia.

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