Observations Concerning the Clinical and Metabolic Effects of Corticosterone (Compound B) in Rheumatoid Arthritis 1

Abstract

Corticosterone is a naturally occurring adrenal corticosteroid which has been isolated from adrenal gland extracts (1,2), adrenal perfusates (3, 4) and adrenal vein blood (5). Biosynthesis has made this steroid available for clinical studies. It has been demonstrated to influence carbohydrate, nitrogen, and electrolyte metabolism (6, 7), but to be devoid of antirheumatic effects (8). These studies were undertaken to investigate further its metabolic and antirheumatic properties. PROCEDURECorticosterone was administered by mouth in doses of 100 milligrams every 8 hours for 8 days to one patient with typical, moderately severe rheumatoid arthritis. All treatment was discontinued prior to the experiment with the exception of 20 hours bed rest per day and active bed exercises twice daily. Subjective changes in the arthritis were determined daily by questioning the patient on the degree of fatigue, weakness, aching, stiffness, soreness, and pain at rest. Objective changes were determined daily by inspection and palpation of the involved structures by two observers. Balance studies were performed on constant diet and fluid intake by methods described by Reifenstein, Albright, and Wells (9). Stools were collected in four-day periods, and urines in two-day periods. Oral arterial and venous glucose tolerance tests were carried out during the control period and at the termination of treatment.Case summary. The patient, a 34 year old male (MGH No. 717532), had enjoyed good health until twenty-seven months before admission, when he developed pain and stiffness of the temporomandibular joints. These symptoms subsided within two weeks. He remained well until twenty-three months before entry, when he developed pain, stiffness, and swelling of the elbows, wrists, fingers, knees, and ankles. His symptoms remained constant until fifteen months before entry, when pain in the hips,