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Cortisone: Contraindications and Indications
By Eugene F. Boggs, M.D.

Emphasis is placed on the damage done by this drug, such as addiction, withdrawal difficulties and on the surgical hazards.

Side Effects of Cortisone and ACTH Compounds:

  1. Psychoneurosis
  2. Sodium Retention and Edema
  3. Diabetes to Infection
  4. Pancreatitis
  5. Addiction
  6. Surgical Hazard
  7. Lowered Resistance

We have seen the most noteworthy discoveries, such as sulfa-chemotherapy, a long list of antibiotics, and more recently, ACTH and cortisone publicized in the most extravagant and injudicious way. The effect: an impatient public has been led to believe we can cure anything and do it right now. The end result: multitudes of disillusioned laymen and many cynical nihilistic doctors.

Cortisone, the agent under special consideration, will relieve painful swollen joints. Intra-articular hydrocortisone injections will practically relieve for varying lengths of time. Dr. Russell Cecil has commented that cortisone is the answer in less than 10% of these problems. Dr. Walter Bauer has very recently emphasized the hazards rather than the benefits of this drug.

Rheumatoid arthritis etiology still remains obscure and its treatment is still in the "try and try again" state.

A great diagnostic error is made by failing to differentiate rheumatoid arthritis from the very common degenerative arthritis. Rheumatoid arthritis occurs from 8 to 80 in both sexes, the incidence being highest in the female. It may be very insidious in onset, or very rapid. The course is usually one of long, drawn-out invalidism with flexion-contraction deformities common.

Cortisone does not cure rheumatoid arthritis but suppresses it. The nutritional status suffers with concomitant anorexia, muscle wasting and secondary hypochromic ,anemia. These facts all must be considered in treatment.

A very high percentage of the women patients are childless. For some obscure reason, they marry mates who accept their invalidism and continue to be over-solicitious

Many rheumatoid arthritics in a state of invalidism remain cheerful and happy, at times euphoric. The seclusion of invalidism and the ministrations of husband or family over the years are accepted, and life is tolerated with an air of passive resignation that excites the wonder, pity, and every horror of those about them.

CORTISONE ADDICTION

There is great risk in cortisone administration for patients with psychoneurotic tendencies. The transitory euphoria and improvement are generally followed by fixed addiction; and let it be emphasized strongly at this point that cortisone is an addictive drug. Withdrawal is followed by a disastrous exacerbation of all preceding symptoms plus intense psychoneurotic reactions. Cortisone is notorious for its bad side effects, disturbing the psycho-emotional status.

One of its specific actions is a resolution of fibrous tissue and actual inhibition of fibroplasia by the fibroblasts. Rheumatoid arthritis is characterized by excessive production 'of fibrous tissue or pannus, which overgrows the joint surface and obliterates the joint spaces. Obviously, cortisone would act immediately and rapidly in causing resolution of palms and hence the dramatic picture of the stiffened cripple "Kicking up his heels."

What about the withdrawal phase? Fibroalysis ceases; fibrosis begins to return; the euphoria and heightened optimism produced by cortisone disappear, and the old symptoms reappear. The patient does not know whether to "cuss, complain or cry." In many with serious psychoneurotic taints and even submerged psychotic tendencies, fulminant psychic changes appear. Our population is now littered with cortisone cripples, psychic and musculoskeletal.

Prolonged administration of cortisone reduces the size of the adrenal cortex and thus produces chronic adrenal exhaustion or acute adrenal failure and collapse. Patients who have been on cortisone for any length of time are surgical hazards. An increasing number of cases of deaths during surgery or soon thereafter are being reported. A surgical wound may not heal or heals with difficulty. It is wise to advise a surgeon of the history of cortisone intake of any patient referred.

Rhematoid arthritics all seem to exhibit a deficiency in the absorption and assimilation of iron. Parenteral liver plus B12 seems to accelerate the beneficial effects of iron by mouth.

High-potency vitamins with trace tninerals, a highprotein diet, tonics to stimulate appetite, systematic graduated exercises, and physiotherapy may add to the patient's comfort. Whole blood transfusions help greatly in severely debilitated cases.

Reprinted-from Clinical Medicine

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