Management of Rheumatoid Arthritis With Smaller (Maintenance) Doses of Cortisone Acetate

Boland, Edward W.; Headley, Nathan E.

doi:10.1001/jama.1950.02920050005002

Cited by 59 publications

(12 citation statements)

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“…2 3 Systemic glucocorticoid treatment is associated with osteoporosis, an increased risk of fracture, and the morbidity and mortality associated with fractures. [4][5][6][7] This risk increases rapidly after the onset of treatment and is observed with doses of prednisolone of less than 7.5 mg daily. 3 Bisphosphonates increase bone mineral density (BMD) and can prevent fractures in postmenopausal women with osteoporosis who are not receiving glucocorticoids.…”

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confidence: 99%

Five year study of etidronate and/or calcium as prevention and treatment for osteoporosis and fractures in patients with asthma receiving long term oral and/or inhaled glucocorticoids

Douglas²,

Rm³

et al. 2004

Thorax

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mentioning

confidence: 99%

Five year study of etidronate and/or calcium as prevention and treatment for osteoporosis and fractures in patients with asthma receiving long term oral and/or inhaled glucocorticoids

Douglas²,

Rm³

et al. 2004

Thorax

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“…10 In 1987, Atkinson et al 18 reported osteonecrosis for the first time following allogeneic bone marrow transplantation. Although few reports have addressed this complication of allogeneic stem cell transplantation, [19][20][21][22][23] improvement in the detection of this late complication with its attendant morbidity is of increasing importance.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Treatment with corticosteroids is another risk factor in the pathogenesis of osteonecrosis as first mentioned in 1950. 10 Therefore, avascular necrosis is a well-described complication after renal and cardiac transplantation, especially in patients receiving high-dose steroids for graft rejection. [10][11][12][13][14][15][16][17] In 1987, Atkinson et al 18 first described a 10% incidence of osteonecrosis after allogeneic bone marrow transplantation from HLA-identical sibling donors.…”

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confidence: 99%

“…10 Therefore, avascular necrosis is a well-described complication after renal and cardiac transplantation, especially in patients receiving high-dose steroids for graft rejection. [10][11][12][13][14][15][16][17] In 1987, Atkinson et al 18 first described a 10% incidence of osteonecrosis after allogeneic bone marrow transplantation from HLA-identical sibling donors. Since then, few studies have addressed this late complication.…”

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confidence: 99%

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Avascular necrosis of bone following allogeneic stem cell transplantation: MR screening and therapeutic options

Wiesmann

Pereira

Böhm

et al. 1998

Bone Marrow Transplant

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Summary:With improvement in long-term survival after allogeneic stem cell transplantation, late complications with significant morbidity are of increasing importance. We retrospectively analysed 272 recipients of an allogeneic stem cell transplant for the development of osteonecrosis. The incidence among allograft recipients was 6.3% (17/272) for the whole patient population, and 11.8% (17/144) for long-term survivors. All patients were treated with high-dose prednisolone, 16 for severe acute or extensive chronic graft-versus-host disease (GVHD) and one patient for graft rejection. The mean age at time of diagnosis was 33 years (range 16-45) and the mean time from transplant to diagnosis of osteonecrosis was 13 months. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allows early detection of osteonecrosis and assessment of stage. At the time of diagnosis, eight patients had stage I, three patients stage II, three patients stage III and three patients stage IV osteonecrosis according to MR criteria. All but one patient had involvement of the femoral head. The median total dosage of prednisolone at the time of diagnosis was 189 mg/kg (single manifestation 150 mg/kg; multiple manifestations 313 mg/kg) with a total range of 13-555 mg/kg. Six patients were treated by conservative means, 77 patients underwent surgery (three core decompression, eight joint replacement). MR screening of patients receiving highdose steroids might help to detect osteonecrosis at an early stage and thus prevent progression by early intervention, for example, by core decompression. Keywords: avascular necrosis; allogeneic stem cell transplantation; magnetic resonance-steroids With improvement in long-term survival after allogeneic bone marrow transplantation, late complications with significant morbidity are of increasing importance.Osteonecrosis is a general term applied to conditions resulting in necrosis of bone and marrow elements. Avascular necrosis indicates involvement of the epiphysis or subCorrespondence: Dr H Einsele, Department of Hematology and Oncology, University of Tübingen, Otfried Müller Str. 10, 72076 Tübingen, Germany Received 9 March 1998; accepted 20 April 1998 chondral bone, whereas osteonecrosis of the metaphyseal or diaphyseal bone is commonly referred to as bone infarct.

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“…Boland and Headley treated their patients with less severe arthritis with one-fourth of the original dose of cortisone [50]. A trade-off was achieved: the control of arthritis was adequate, although not complete, but fewer unfavorable side-effects were encountered.…”

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confidence: 99%

Cortisone Therapy: A Challenge to Academic Medicine in 1949-1952

Hetenyi¹,

Karsh²

1997

pbm

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On September 21, 1948, at the Mayo Clinic in Rochester, Minnesota, Charles Slocumb and Philip Hench injected 50 mg of a "new" steroidCompound E, first isolated by their biochemist colleague Edward Kendall from adrenal glands 12 years ago-into a young woman suffering from acute rheumatoid arthritis. The injection was repeated in the afternoon and twice again on the 22nd. By the 23rd the patient conspicuously improved and within a week the remission was near complete [I].The circumstances of the discovery reflect the era in which it was made [2] . In the years following the second World War, medicine and in particular medical science were imbued with postwar optimism. The thrill created by advances in cell biology, biochemistry, immunology, and physiology inspired physicians to put the new knowledge into practice and stimulated patient-oriented clinical research more than ever before or since. Academic physicians studied their patients on the ward and tried to account for their clinical observations and discover a therapy. This close link between the wards and the laboratory raised potential dilemmas. Obviously, the wellbeing of the patient was the supreme concern. But attempts to learn more about the disease and the search for a cure were sometimes "audacious"[2]. There were no formal institutional ethics committees to advise. Ethical problems were considered at rounds and discussions by staff, often including the patient. This atmosphere encouraged research, and real breakthroughs were achieved.What was the rationale for the new therapeutic trial? Today, a half cen-

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Management of Rheumatoid Arthritis With Smaller (Maintenance) Doses of Cortisone Acetate

Cited by 59 publications

References 4 publications

Five year study of etidronate and/or calcium as prevention and treatment for osteoporosis and fractures in patients with asthma receiving long term oral and/or inhaled glucocorticoids

Five year study of etidronate and/or calcium as prevention and treatment for osteoporosis and fractures in patients with asthma receiving long term oral and/or inhaled glucocorticoids

Avascular necrosis of bone following allogeneic stem cell transplantation: MR screening and therapeutic options

Cortisone Therapy: A Challenge to Academic Medicine in 1949-1952

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