Evaluation of prolonged cortisone therapy in rheumatoid arthritis: A four-year study

Abstract In this report are presented the data collected from observation over a four-year period of seventy-eight patients with rheumatoid arthritis (including nine cases of juvenile rheumatoid arthritis) who were treated with cortisone for intervals varying from a few weeks to almost four years. The patients were examined every four weeks or more frequently. The results have been analyzed to yield information concerning the following: composition of the group according to certain clinical features of rheumatoid arthritis; age and sex distribution; duration and stage of arthritis; duration of cortisone therapy; average daily maintenance dose; functional improvement as measured by four different criteria; relation of duration of therapy to grade of therapeutic response; comparison of certain factors in the groups that exhibited Grade I and Grade III or IV response; behavior of subcutaneous nodules during therapy; appearance or extension of bone destruction despite maintenance therapy and good clinical response; occurrence of undesirable effects including peptic ulcers, fractures and one death from overwhelming sepsis. An attempt is made to determine what effect, if any, cortisone exercises on the natural course of rheumatoid arthritis. The factors which may inadvertently influence or even prejudice results achieved by an agent subjected to clinical trial in this disease are discussed.