Small doses of prednisolone in the management of rheumatoid arthritis

Throughout its 15-year history the treatment of rheumatoid arthritis with corticosteroids has pre-sented clinicians with a succession of differing aspects-first a brief flash of hope that most of the problems of the disease had been solved, then a sombre picture of impermanent benefit bought at too great a cost in terms of undesirable effects, and last a more balanced scene of limited objectives and greatly reduced dangers. The dose of cortisone empirically chosen for the earliest clinical trials (Hench, Kendall, Slocumb and Polley, 1949) was commonly 100 mg./ day, equivalent to about 20 mg. prednisolone. Prolongation of treatment at this level of admini-stration soon revealed the adverse effects which induced many clinicians to abandon the use of corticosteroids entirely and others to accept the les