Studies on dexamethasone, a new synthetic steroid, in rheumatoid arthritis—a preliminary report

Abstract

Observations concerning the antirheumatic and physiologic effects of a new synthetic corticosteroid, dexamethasone, are presented. This preparation, the most potent of any steroid heretofore studied, did not cause sodium retention or potassium loss in doses sufficient to suppress rheumatoid disease. Increased nitrogen and calcium excretion were observed. Further clinical studies are indicated. For the present, it is suggested that the daily dose of dexamethasone should not exceed 4 mg.Es presentate observationes relative a1 effectos antirheumatic e physiologic del nove corticosteroide synthetic, dexamethasone. Iste preparato, le plus potente de omne le steroides usque nunc studiate, non causava retention de natrium o perdita de kalium quando usate in doses sufficiente a supprimer morbo rheumatoide. Augmentos del excretion de nitrogeno e de calcium esseva observate. Studios clinic additional es indicate. Por le momento, il es suggerite que le dose diurne de dexamethasone non excede 4 mg* EXAMETHASONE' is delta-1,Y-a fluoro,l6a methyl hydrocortisone. In D other words, it is a prednisolone analog to which have been added a fluorine atom at carbon 9 and a methyl radical at carbon 16. This compound was synthesized by a team of scientists1 who studied its glucocorticoid, mineralocorticoid and anti-inflammatory properties in rats and found it to have the following potencies: adrenal atrophy, 700 times hydrocortisone involution of thymus, 400 times hydrocortisone granuloma inhibition, 190 times hydrocortisone body weight depression, 100 times hydrocortisone and glycogen deposition, 17 times hydrocortisone. In adrenalectomized rats dexamethasone produced neither sodium retention nor potassium loss.It will be recalled that prednisone was the first of the synthetic, biologically active 11,17 oxysteroids that was found to have enhanced anti-inflammatory potency (compared to hydrocortisone) and yet was free of the objectionable effects of sodium retention and potassium loss2 It was not, however, free of ~~

Visceral Scleroderma without Skin Involvement

“…Our balance studies (Nordin, 1961) have shown that the faecal calcium content in cases of steatorrhoea is slightly higher than that of normal subjects at the same intake levels, but the difference is a relatively small one. The results obtained in patients on steroid therapy are also compatible with our own previous observations and with those of other workers (Bunim et al, 1958;Slater et al, 1959). On moderate doses of corticosteroids the only consistent abnormality of calcium balance so far observed is an impairment of calcium absorption.…”

Effects of Cloprednol and other Corticosteroids on Hypothalamic-Pituitary-Adrenal Axis Function

“…The duration of suppression for triamcinolone was longer (about fifty-four hours), and was longest for dexamethasone and beta methasone (about sixty-six and seventy-six hours, respectively). Bunim et al (1958) reported that 1 mg of dexamethasone given at midnight resulted in total suppression of 8 a.m. plasma Cortisol, whereas 30 mg of prednisone was required for total suppression of plasma Cortisol the following morning. Since the anti-inflammatory activity of dexa methasone in rheumatoid arthritis was only il| six times tiiat of prednisone, it is apparent that equipotent doses of dexamethasone were much more suppressive of the HPAaxis than prednisone.…”

Safety of perioperative dexamethasone administration in children: time for reflection?

“…2 Au cours des deux décennies suivantes, l'utilisation de la dexaméthasone en tant qu'agent anti-inflammatoire puissant a été explorée, et on a rapidement découvert que le médicament offrait des avantages dans des situations cliniques telles que l'extraction des dents de sagesse 3 et la laryngotrachéobronchite aiguë (croup). 4 Il a fallu davantage de temps avant de reconnaître l'action antiémétique puissante de la dexaméthasone, bien que cet effet ait déjà été démontré dans les premières études.…”

“…2 Over the following two decades, the use of dexamethasone as a potent anti-inflammatory agent was explored, and the drug was soon found to be beneficial in such clinical situations as third molar extraction 3 and acute laryngotracheobronchitis (croup). 4 The potent antiemetic action of dexamethasone was somewhat slower to be recognized, even though this had been shown in early studies.…”