Serial studies of synovial fluid in evaluating intra-articular agents.

One of the most difficult problems in the study of rheumatic diseases is the evaluation of an antiinflammatory response. That this is true in intraarticular as well as systemic therapy is illustrated by the divergence of results reported in the literature. For example, Cohen and others (1954) concluded, by purely clinical evaluation in a large number of patients, that cortisone acetate was equally as effective as hydrocortisone acetate, while studies based on more objective criteria by Duff and others (1951), Hollander and others (1951), Stevenson and others (1952), Ziff and others (1952), and Kersley and Desmarais (1952) clearly demonstrated its relative ineffectiveness. The present study poses two questions: (1) What are the changes in the synovial fluid examined by the usual techniques after the intraarticular administration of an agent of known effectiveness-hydrocortisone acetate? (2) Will serial analyses of synovial fluid permit evaluation in a limited number of patients of an agent ofunknown effectiveness-hydrocortisone ? The latter preparation differs from hydrocortisone acetate in its increased solubility in synovial fluid (Macek and others, 1952), and is, therefore, of considerable theoretical interest.