L. Emmerson Ward

Giant-cell Arteritis Producing an Aortic Arch Syndrome

Excerpt Patients with giant-cell arteritis (temporal or cranial arteritis) have long been recognized to have involvement of arteries other than the temporal arteries. Although typical lesions have ...

Diagnosis, treatment and prevention of chronic hypercortisonism in patients with rheumatoid arthritis.

Excerpt In the relatively brief period of six years of intensive clinical and biochemical investigations, the great potency of cortisone, corticotropin and related adrenocortical hormonal preparati...

Prednisone in Rheumatoid Arthritis: Metabolic and Clinical Effects

The initial reports (Hench, Kendall, Slocumb, and Polley, 1949; Sprague, Power, Mason, Albert, Mathieson, Hench, Kendall, Slocumb, and Polley, 1950; Hench and others, 1950) of the antirheumatic potency of cortisone emphasized the fact that excessive doses produced not only desirable but also certain undesirable effects. At that time (1949), we expressed our hope and belief that analogues superior to cortisone would be discovered. Since then, at least seven more cortisone-like steroids have been found useful clinically; these include hydrocortisone, 9-alpha-fluorohydrocortisone (Fludrocortisone), prednisone, prednisolone, a compound whose structure is 9-alpha-fluoro, delta 1-hydrocortisone, and the two most recent additions, namely triamcinolone and 6-methyl, delta I-hydrocortisone. Each of these eight compounds has distinctive characteristics. Cortisone is the least costly to prepare synthetically; it is still useful in many cases and preferable in some. Hydrocortisone, apparently the major product of the normal human adrenal cortex, has proved to be superior to cortisone in local, especially intra-articular, administration. Fludrocortisone possesses a greatly enhanced antirheumatic effect (about ten times greater than that of cortisone, milligram for milligram); however, its effect on the retention of sodium and chloride and the excretion of potassium is even more enhanced. Thus, fludrocortisone is especially useful in the adrenal insufficiency of Addisons disease and when used in ointments for certain dermatological conditions, but the qualities that make it superior to cortisone or hydrocortisone in the management of Addisons disease interfere with its usefulness for rheumatic patients. Nevertheless, its production represented a distinct advance, because it demon-

EFFECTS OF ALDOSTERONE (ELECTROCORTIN), 9 ALPHA‐FLUOROHYDROCORTISONE ACETATE, AND 1‐DEHYDROCORTISONE (METACORTANDRACIN) IN RHEUMATOID ARTHRITIS

Since the discovery of the antirheumatic and anti-inflammatory effects of cortisone, many different steroids have been investigated in an effort to find superior compounds for the treatment of rheumatoid arthritis and other diseases whose manifestations are inhibited by cortisone. The physiologic properties other Lhan antirheumatic activity have been studied in certain of these substances also. The finding that slight modifications in the steroid molecule may lead to compounds with markedly different activities is not surprising. Nevertheless, it has not been possible in the past to predict with much accuracy what differences certain changes in structure might produce, a few notable exceptions notwithstanding. Now, various studies are defining more clearly the structural requirements for steroids with antirheumatic activity. These studies also suggest that certain structural alterations may modify specific physiologic activities of these cortisonelike antirheumatic steroids without diminishing or destroying, but sometimes even enhancing, their desirable antirheumatic capacities.

Effect of hyperuricemia on renal function in the dog.

Summary Renal function in dogs, as assessed by the clearances of creatinine and para-aminohippurate, was impaired by hyperuricemia induced by intravenous injections of uric acid. The degree of functional impairment was related to dosage and to frequency of injection and was possibly aggravated by the presence of renal disease. It was more severe in mongrel than in Dalmatian dogs. Small doses, which singly produced no detectable functional impairment, caused renal damage after repeated daily injections, indicating a cumulative effect. The findings suggest that hyperuricemia may produce significant nephropathy by urate blockage of the distal convoluted and collecting tubules. Such hyperuricemic nephropathy, reversible up to a certain point, may become chronic or fatal if permitted to continue unchecked.

Multiple Myeloma With Amyloid in Synovium

A 57 year old woman complained of pain and swelling of multiple joints. She tired easily, her joints were stiff in the morning, and she could move them better after activity. In addition, she had nodules on her palmar flexor tendons, bilateral carpal tunnel syndrome, and changes in the bones of her hands that looked like those of early rheumatoid arthritis.