STEROID-INDUCED GASTRIC ULCER

Lack of knowledge about the diseases being treated is a major difficulty in assessing the significance of the "therapeutic complications" attributed to corticosteroids. Prominent among the complications is an apparent increase in peptic ulceration (both duodenal and gastric). An investigation reported in 1960, which covered nearly 3,000 rheumatoid arthritis patients, indicates that the recognized incidence of peptic ulcer in rheumatoid arthritis patients seen prior to the steroid era was 3.3%, whereas the incidence for the general patient population was 1%-3%.¹ In rheumatoid arthritis patients seen in 1954 and 1957, but not treated systemically with steroids, the incidence of peptic ulceration was 8.1%. This difference is not easily explained; possibly the incidence of peptic ulcer in rheumatoid patients, or the frequency with which it was recognized, or both, were increasing. The 8.1% incidence of peptic ulcer in the patients not treated systemically with corticosteroids is comparable to an incidence of