Intra-articular hydrocortisone (compound F) acetate; a preliminary report.

The suppression of inflammation in the joint structures of patients with rheumatoid arthritis by cortisone acetate administered systemically is well known. Hydrocortisone acetate, formerly known as Compound F acetate (17-hydroxycorticosterone-21-acetate), administered orally or intramuscularly, has recently been shown to have a similar suppressive effect upon this inflammation (Ward and others, 1951; Freyberg, Stevenson, Traeger, and Zuckner, 1952). One of the most important objections to the systemic use of these steroids is that amounts adequate to produce a beneficial effect may cause undesired physiological changes of hyperadrenocorticalism. Thorn (1951) is reported to have been the first to inject hydrocortisone acetate into an inflamed joint of a patient with rheumatoid arthritis with improvement in the inflammation. Hollander and others (1951) reported sustained local benefit and no systemic effect, after intra-articular injections of hydrocortisone into patients with various illnesses including rheumatoid arthritis. They reported no objective improvement after intra-articular injections of cortisone -acetate. Other workers have demonstrated that cortisone acetate injected directly into an inflamed joint produces local improvement which is manifested clinically and by changes in the synovial fluid without producing a significant systemic effect (Freyberg and others, 1951). After repeated intra-articular injections of cortisone acetate, however, the response in most patients becomes less. In a few others this material seemed to be irritating as shown by worsening of the inflammation at the joint treated and an increase in the number of cells in the synovial fluid. The present study deals with clinical and synovial fluid changes observed after intra-articular injections of hydrocortisone acetate in patients with rheumatoid arthritis. Procedure Hydrocortisone acetate was supplied for this investigation§ in two forms: the usual aqueous suspension (25 mg. per 1 0 ml.) containing Tween-80 and butyl alcohol, and also the dry crystalline state. The crystalline material was studied to determine whether any of the effects observed with the usual suspension were produced by any of its components apart from the steroid. The physical instability and uneven suspension of the