The Treatment of Rheumatoid Arthritis With Adreno‐corticosteroids and Their Synthetic Analogues: An Appraisal of Certain Developments of the Past Decade*

Boland, Edward W.

doi:10.1111/j.1749-6632.1960.tb44970.x

Cited by 12 publications

(7 citation statements)

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“…By the end of the 1950s, leading Californian rheumatologist Edward Boland, who had been one of the five participants in the early cortisone trials in the United States, wrote influential reviews of the ‘relative therapeutic efficiencies’ of chemically modified adreno-corticosteroids in RA (Boland 1959; 1960). In both reviews he was clear that new analogues had superseded the once-miraculous cortisone.…”

Section: And Aftermentioning

confidence: 99%

“…A sound comprehensive program should be employed concomitantly; this would consist of well-regulated rest and exercise, properly balanced diet, avoidance of undue emotional stress, physiotherapeutic procedures and graded muscle exercises, careful handling of affected joints with proper supports and splints, occupational and rehabilitative measures, and simple analgesics. (Boland 1959, p. 888)Ending therapy needed careful management too: ‘treatment must be gradually discontinued or “tapered off’’—not suddenly withdrawn. ’The physician’s goal, as ever, was to balance benefits and risks: ‘to promote and uphold that degree of disease suppression that is feasible with dosages that are well tolerated on a long-term treatment basis.’ In his review a year later, Boland’s verdict was that results with the new corticosteroids had been mixed.Some possess advantages in one respect or another, but none is divested of the major deterrent features of corticosteroid therapy, and some produce peculiar objectionable reactions of their own.…”

Section: And Aftermentioning

confidence: 99%

“…Because of a lack of published comparative data and misleading promotional pharmaceutical advertising, physicians have been confused regarding the relative merits, special properties, and tendencies to unwanted reactions of these newer preparations. (Boland 1959, p. 888)With experience and the use of clinical acumen, informed by trials and case reports, rheumatologists could adopt the new drugs selectively, finding them niches in their multi-strand therapies, adjusted to individual patients and their disease.…”

Section: And Aftermentioning

confidence: 99%

Section: And Aftermentioning

confidence: 99%

Section: And Aftermentioning

confidence: 99%

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Special issue—before translational medicine: laboratory clinic relations lost in translation? Cortisone and the treatment of rheumatoid arthritis in Britain, 1950–1960

Worboys

Toon

2019

HPLS

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Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis (RA). Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine (TM). In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today.

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Section: And Aftermentioning

confidence: 99%

Section: And Aftermentioning

confidence: 99%

Section: And Aftermentioning

confidence: 99%

Section: And Aftermentioning

confidence: 99%

Section: And Aftermentioning

confidence: 99%

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