Prednisone and Prednisolone Therapy in Rheumatoid Arthritis

Rheumatoid arthritis was treated in 156 patients by oral administration of either prednisone or prednisolone. The initial dosage ranged from 10 to 40 mg. per day, given in divided doses at approximately six-hour intervals. In most patients, 10 mg. or less per day sufficed for maintenance. Therapy was continued for periods ranging from 4 to 14 months. Observations showed general improvement in the patients by subjective and objective criteria; functional capacity was increased, and 38 of the 59 adult male patients were enabled either to return to work or to continue their work status. Side-effects of these drugs were, in general, not disturbing, but the incidence of gastrointestinal complaints increased from 11 to 21%. Peptic ulcers appeared in some patients in whom the roentgenograms had not shown such lesions before treatment. Among five patients who developed complications of peptic ulcer, three developed hemorrhages and two suffered perforations. Because these complications offset somewhat the undeniable benefits of the prednisone and prednisolone to arthritic patients, there is urgent need for the development of drugs that will be equally effective and less marred by side-effects.