Prednisone and Prednisolone in the Treatment of Rheumatoid Arthritis

EXPERIENCE of the limitations of cortisone and hydrocortisone as therapeutic agents in the management of patients with rheumatoid arthritis has led to a search for newer and more potent compounds with fewer undesirable side effects. With the knowledge that the physiological properties of the adrenal steroids can be modified by relatively minor adjustments of their structural formula, a number of compounds have been synthesised and tried therapeutically. One of the earliest of these, 9x-fluoro-hydrocortisone acetate was tested by Boland and Headley in 1954, who found its anti-rheumatic activity to be about ten times greater than that of hydrocortisone, but unfortunately the drug had marked salt and water retaining properties which prevented its use as a practical method of treatment. More recently prednisone and prednisolone have been synthesised. These two drugs are analogues of cortisone and hydrocortisone respectively, are derived from them, and differ only in having a double bond linkage between the first and second carbon atoms of the steroid nucleus. Bunim, Pechet, and Bollet (1955) were the first to describe their successful use in seven cases of rheumatoid arthritis, and since then further reports have followed confirming the effectiveness of both drugs (Dordick and Gluck, 1955; Margolis, Barr, Stolzer, Eisenbeis, and Martz, 1955; Hart, Clark, and Golding, 1955; and Boland, 1956). At present the general opinion held is that both substances possess an anti-rheumatic effect about three to five times greater than cortisone, and when employed in equivalent therapeutic dosage they have less sodium-retaining properties (Bunim, Pechet, and Bollet, 1955; and Nabarro, Stewart, and Walker, 1955). There is apparently little, if any, difference in the two drugs in respect of their usefulness or side effects (Bunim, Pechet, and Bollet, 1955), and Boland (1955) considered them interchangeable.