Two years' experience of prednisone in rheumatoid arthritis.

Abstract

Early in 1955 Bunim and his colleagues reported on the use of two analogues of cortisone, prednisone ( meta cortandracin ) and prednisolone ( metacortandralone ), in the treatment of rheumatoid arthritis. These two steroids differ from cortisone and hydrocortison? respec tively in possessing a double bond between carbon atoms 1 and 2 of the A ring of the molecule. This small struc tural change is responsible for two notable differences between parent and offspring ; the latter are weight for weight three to four times as potent as cortisone, and they do not cause sodium retention in therapeutic dosage. There is little to choose in action between pred nisone and prednisolone ; in general their effects are the same as those of cortisone, except that they have gained in some quarters a particular reputation for promoting dyspepsia, peptic ulc?ration, and haemorrhage. In 1955 both steroids became available for hospital use and later were released for prescription on form E.C.10. The situation has thus arisen that two powerful drugs, about which comparatively little has been pub lished in this country, are widely available. In this instance a volume of advertising has eclipsed the litera ture, and both steroids can be obtained not only as such but in compound form, either with an antacid or in small amount in combination with aspirin. Satisfactory proof is lacking that the first confers safety or that the second is efficacious. We here record our experience with one of these steroids, prednisone, over a two-year period. It must be emphasized that what follows is a retrospec tive analysis of the practice of a rheumatism clinic, and not a report of an organized clinical trial designed in advance and statistically controlled.