Ten Years of ACTH Therapy

Abstract

Adrenal stimulation therapy, has been attempted in patients suffering from rheumatoid arthritis or ankylosing spondylitis. Particular note has been made of the occurrence of new bone erosions of the hands. The progress of the ACTH-treated patients was very much better than of the Au-treated ones. Mild adrenal stimulation enables sites of potential rheumatoid disease to maintain their integrity. The primary lesion may be due to the inability of certain enzymes (at a particular locus) to deal normally with an environmental agent or autogenous antibody. This may be due to a relative deficiency of a particular factor the inactivation or synthesis of which is promoted by raising the concentration of 1 or more adrenocortical hormones. If the deficiency is marked, the permissive action of the hormones may be ineffective. Relatively high concentrations, of hydrocortisone (or an analogue) would suppress the resulting non-specific inflammatory reaction but would not lead to resolution and healing.