Practical considerations of the use of cortisone and ACTH in rheumatoid arthritis.

The original and subsequent reports concerning the clinical effects of cortisone and ACTH (Hench and others, 1949; Thorn and others, 1949; Freyberg, 1950; Thorn and others, 1950a, b, and c; Sprague and others, 1950; Hench and others, 1950) clearly indicate that these hormones have profound effects in the human, producing great benefit on various rheumatic states so long as the hormone is administered, and that these effects cease soon after the administration of the hormones is discontinued. In acute illnesses, such as attacks of gouty arthritis or acute rheumatic fever, administration of these hormones can be expected to benefit the patient greatly, and on account of the short periods of administration there is little or no difficulty from undesired physiological effects of the hormone-producing complications. In chronic illnesses, such as rheumatoid arthritis, greater difficulties surround the use of cortisone and ACTH, for it is evident that the underlying disease process is not eliminated by a short period of administration, and prolonged vigorous use may produce serious side-effects. The practical problem, therefore, is: How can cortisone or ACTH be effectively and safely used in patients with chronic rheumatoid arthritis ?