Two new synthetic steroids, prednisolone and prednisone, formerly known as metacortandralone and metacortandracin, respectively, have recently been introduced as antirheumatic agents in rheumatoid arthritis.1 They have been found to be four times more potent than cortisone in suppressing the inflammatory joint changes produced by the disease. They also cause depletion of the circulating eosinophils and significant reduction of urinary 17-ketosteroid excretion. In contrast to cortisone, administration of the new steroids is not associated with sodium and water retention or with potassium loss. Early experience with the new steroids revealed the occurrence of minor undesirable side-effects, such as facial rounding, hirsutism, diminished carbohydrate tolerance, insomnia, restlessness, weakness, transitory mental clouding, acne, increased skin pigmentation, and vague abdominal distress.
The purpose of this paper is to report three cases of major undesirable side-effects that occurred in a series of 18 successive cases of rheumatoid arthritis treated with prednisolone or prednisone. A