CORTISONEPLUSINSULIN IN THE PALLIATIVE TREATMENT OF RHEUMATOID ARTHRITIS: A PRELIMINARY STUDY

Abstract

Daily injn. of 25-50 mg. cortisone and 20-60 units of plain insulin produced symptomatic and objective improvement in 11 of 12 adults with typical rheumatoid arthritis studied for 30 days in hospital. The effect of 50 mg. and in some instances 25 mg., with insulin, was comparable with that of 100 mg. cortisone alone, and was unattended by side effects. Protamine zinc insulin did not enhance the action of cortisone. Insulin alone was found ineffective. Hypoglycemia was avoided, and was controlled by feeding carbohydrate. To cortisone is ascribed an unphysiologic distortion of the carbohydrate-action of native adrenocortical hormone (as yet unrecognized), leading to deposition of material in the cell surface-boundary such as enhances refractoriness to noxae (though they persist) and blocks the inflammatory response. Insulin was given to support the action by making carbohydrate available; cellular protein, as source of material, is spared. With or without insulin, cortisone is merely a temporary and palliative expedient that fails to approach the disease itself; with insulin, it may be less harmful.