EDITORIAL - Matching therapy to body rhythms: an endocrine approach to treating RA

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Journal of Rheumatology

Editorial

Oct 2010

Matching Therapy to Body Rhythms: An Endocrine Approach to Treating

Rheumatoid Arthritis

The value and efficacy of corticosteroids in treatment of rheumatoid

arthritis (RA) has been recognized ever since the Nobel Prize in

Physiology and Medicine was awarded in 1950 for the astonishing

discovery of Kendall, Philip Hench, and Tadeus Reichstein1. The

description of Hench’s treatment of the first patient with Kendall’s

compound E (later known as cortisone) reads like a story out of the

annals of the miracle cures at Lourdes2. The young woman, unable to

walk and bedridden with severe debilitating RA for 4 years, gets up,

walks and leaves hospital recovered, only 4 days after treatment with

daily intramuscular injections of the drug. The Nobel Prize was

awarded to this team only one year after this observation, and after

treatment of another couple of dozen patients3. Prednisone has since

been a mainstay of treatment of RA and other inflammatory/autoimmune

conditions.

The major stumbling block for this otherwise miraculous drug has been

its severe side effects when used in high doses and for prolonged

periods of time. These include adrenal insufficiency; osteoporosis;

metabolic syndrome, including diabetes; central fat deposition; skin

atrophy; “moon” face; impaired resistance to infection, with increased

severity and frequency of sometimes life-threatening infections; and

the sometimes under-appreciated side-effect of severe mood disorders

including hypomania, manic symptomatology, and severe depressive

disorder, including suicidality4,5. These are not surprising in light

of the similar symptoms seen in Cushing’s disease patients with

pituitary tumors and elevated levels of the endogenous hormone

cortisol.

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Read the entire editorial here:

http://jrheum.org/content/37/10/1981.full

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