The administration of
cortisone acetate to patients with
rheumatoid arthritis usually produces prompt and often dramatic suppression of the disease manifestations. The effects of the
hormone are not lasting, however, and after withdrawal relapse ensues. For sustained improvement in a
chronic disease such as
rheumatoid arthritis, it appears that
cortisone must be given more or less continuously. This raises the question whether administration may be continued effectively and safely for long periods.Seventy-six patients with
rheumatoid arthritis were given
cortisone in the hope that treatment could be continued uninterruptedly for extended periods. For various clinical reasons it was necessary to discontinue treatment in 16 of these before six months, but the remaining 60 patients received the
hormone uninterruptedly for six to 15 months. By using initial large suppressive amounts, then gradually reducing the dosage, and finally employing smaller maintenance doses, adequate degrees of rheumatic control were maintained in approximately two-thirds of the original 76 patients. The ability to sustain satisfactory improvement varied indirectly, in general, with the severity of the
rheumatoid arthritis. The chief detriment to better results in the more severe cases was the intervention of adverse hormonal side effects which developed frequently when large or relatively large maintenance doses were required to support satisfactory improvement. Unwanted signs of hormonal excess developed in 40 per cent of cases at some time during the course of treatment. Most of them were mild or transient and disappeared or lessened when the dose of
cortisone was reduced, but when the dose was reduced the degree of improvement often declined also. During prolonged
cortisone therapy evidence of functional suppression of the adrenal cortices, as indicated by a decreased response of circulating eosinophils to exogenous
ACTH, was present. The depression of cortical function was temporary, however. Whether irreversible damage may result when the
drug is employed for longer periods cannot yet be answered.