Philip S. Hench

THE REVERSIBILITY OF CERTAIN RHEUMATIC AND NONRHEUMATIC CONDITIONS BY THE USE OF CORTISONE OR OF THE PITUITARY ADRENOCORTICOTROPIC HORMONE

Excerpt It may be appropriate to discuss in this Nobel Lecture three general aspects of cortisone and pituitary adrenocorticotropic hormone (ACTH): (1) the development of the theory which eventuall...

THE CAUSES OF DEATH IN THIRTY CASES OF RHEUMATOID ARTHRITIS

Excerpt Rheumatoid arthritis is not just a disease of joints. It is a systemic disease characterized by manifold physiologic alterations and often by multiple symptoms. Despite its systemic nature,...

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...

THE PRESENT STATUS OF RHEUMATISM AND ARTHRITIS: REVIEW OF AMERICAN AND ENGLISH LITERATURE FOR 1936: (Fourth Rheumatism Review)

Excerpt CONTENT General incidence of rheumatic disease Classification Diseases of joints related to trauma Gonorrheal rheumatism: gonococcus arthritis Tuberculous arthritis and tuberculous rheumati...

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-

The Cerebrospinal Fluid in Rheumatoid Spondylitis

Abnormalities in the chemistry of cerebrospinal fluid in cases of rheumatoid arthritis and of rheumatoid spondylitis have been reported: the total protein may be increased in amount, and at times there may be abnormalities in the colloidal gold reaction. The present study was designed to determine how often and at what stages of rheumatoid spondylitis such abnormalities are present, and to evaluate their possible significance. The diagnosis of rheumatoid spondylitis may be difficult in the early stages of the disease when physical and radiographic signs are minimal or absent, when constitutional reactions may be lacking, and when in mild cases even erythrocyte sedimentation rates may be normal. During the early stages of the disease sciatica is present in about 20 per cent. of cases (Boland and Present, 1945). Hence rheumatoid spondylitis must be differentiated at times from other causes of chronic low-back disability accompanied by sciatica, especially from cases of ruptured intervertebral disks, in which the total protein content of cerebrospinal fluid is frequently increased. In these and other circumstances it would be helpful if biochemical studies on cerebrospinal fluid afforded data upon which clear and early differentiations could be made.

THE PRESENT STATUS OF THE PROBLEM OF RHEUMATISM; A REVIEW OF RECENT AMERICAN AND ENGLISH LITERATURE ON RHEUMATISM AND ARTHRITIS

Excerpt IN THREE PARTS PART I CONTENTS: PART I Introductory Rheumatism as a public health problem Clinical content of rheumatism: definitions Types of rheumatism and their relative frequency Indust...

THE ANALGESIC EFFECT OF HEPATITIS AND JAUNDICE IN CHRONIC ARTHRITIS, FIBROSITIS AND SCIATIC PAIN

Excerpt In the last four years I have observed a number of patients whose pain, caused by arthritis, fibrositis or sciatica, was markedly, usually completely, relieved coincident with the appearanc...

GOLD SALTS FOR RHEUMATOID ARTHRITIS

Excerpt Having returned to many professional and economic changes, the homecoming medical officer will have unfortunately found one condition relatively unchanged; namely, the frustrating problem o...

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.