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© 1974 British Society for Rheumatology

research-article

USE OF TRIAMCINOLONE ACETONIDE IN THE TREATMENT OF RHEUMATOID ARTHRITIS WITH DIGESTIVE DISORDERS

A CLINICAL TRIAL SHOWING THE VALUE AND DANGERS OF LONG-ACTING PARENTERAL STEROID THERAPY

G. D. KERSLEY, D. J. GIBSON and F. RING

Royal National Hospital for Rheumatic Diseases Bath

Twenty-four cases of rheumatoid arthritis with digestive disorders have been treated with methylprednisolone (Depo-Medrone) and then triamcinolone acetonide (Kenalog) in equal dosage or double the dosage. It was found that the time interval betweein injections, on average, using the same dose, could be increased from 4–5 to 8–6 days (p<0–001). It was also found that after a series of triamcinolone acetonide injections the time between the injections could gradually be increased and hence the dose reduced. No appreciable gastric symptoms arose. Steroid complications were of the frequency and degree expected, except for two patients who developed symptoms suggestive of mild myopathy. During the process of increasing the time interval between injections two patients had symptoms of adrenal insufficiency. One of these died, and at autopsy the myocardium showed a patchy early necrosis thought to be due to the period of hypotension. There were also widespread amyloid changes in the walls of the smaller arteries and the vasa recta of the kidneys, but surprisingly not affecting the glomerular tufts or tubular basement membrane.


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