DIAGNOSIS, TREATMENT AND PREVENTION OF CHRONIC HYPERCORTISONISM IN PATIENTS WITH RHEUMATOID ARTHRITIS
- 1 January 1957
- journal article
- research article
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 46 (1) , 86-101
- https://doi.org/10.7326/0003-4819-46-1-86
Abstract
Excessive exogenous hormonal dosage with cortisone, hydrocortisone, prednisone, prednisolone or corticotropin may result in either acute (short term) or chronic (prolonged hypercortisonism. Chronic hypercortisonism in rheumatoid patients is characterized by the cyclic and usually associated occurrence of increased fatigability, significant emotional instability and generalized muscular and articular aching, in addition to the other more commonly recognized signs of hypercortisonism. Diffuse mesenchymal reactions simulating systemic lupus erythematosus or periarteritis nodosa also may develop. These diffuse mesenchymal reactions are serious and may be fatal complications of chronic hormonal overdosage but do not reflect the degree of underlying rheumatoid activity, which may or may not be minimal after the rheumatoid patient recovers from the effects of chronic hypercortisonism. When chronic hypercortisonism has occurred in rheumatoid patients, dosage of exogenous hormones needs to be gradually and slowly reduced in conjunction with other treatment until the signs and symptons of excess dosage have disappeared. When reductions of dosage have been too rapid, a flare of the rheumatoid arthritis or other mesenchvmal reaction may develop. If this occurs, the dosage may need to be temporarily increased and thereafter reduced more slowly. In other instances, reversible stages of diffuse mesenchymal reactions occurring in the course of chronic hormonal overdosage may be controlled by temporarily deferring reduction of the hormonal dosage to the desired level. In some patients, hormonal therapy ultimately may need to be discontinued for several months or longer to permit complete disappearance of the signs of hypercortisonism. When signs and symptoms of hypercortisonism have been eliminated, small doses of exogenous hormones within anticipated limits of tolerance for the patient''s age and sex may be used satisfactorily in long-term hormonal therapy if needed. Short periods of increased doses of adrenocortical hormones may be needed for those patients subjected to the added stress of surgical procedures, severe trauma or infections while still receiving hormonal therapy, or who have had signs of hypercortisonism in the 6-12 or more months preceding such stress. The usefulness of these hormones for patients with rheumatoid arthritis is not judged by reactions developing as a result of overdosage. Optimally tolerated doses of cortisone or its effective analogues or corticotropin are potent and valuable therapeutic agents, despite the effects of chronic hormonal overdosage in patients with rheumatoid arthritis. However, in the long-term treatment of rheumatoid arthritis, dosages of exogenous adrenocortical hormones or corticotropin that result in chronic hypercortisonism are not advantageous and should be avoided.Keywords
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