Emeritus Professor of Medicine, Mayo Clinic School of Medicine, Emory University School of Medicine, 211 2nd Street NW, # 1602, Rochester, MN 55901, United States.
Semin Arthritis Rheum. 2021 Feb;51(1):15-19. doi: 10.1016/j.semarthrit.2020.09.016. Epub 2020 Dec 17.
Cortisone was introduced in the treatment of rheumatoid arthritis (RA) in 1948 by Hench and colleagues at the Mayo Clinic which resulted in dramatic improvement of inflammation, function and sense of well-being. It became obvious early on that side effects could develop depending on the dose and duration of use. When cortisone became available in 1950 the practicing physician developed practice patterns without guidance from government agencies, professional organizations or the pharmaceutic industry. The physician did not have guidance about what dose to use or the duration of use, as is available today. In the last 25 years, controlled studies have shown the benefits and safety of low dose prednisone in early RA. The diurnal effect of endogeneous glucocorticoids provides a clue to the timing of a glucocorticoid dose and the duration of the dose is established. The guidelines by the American College of Rheumatology (ACR) particularly but also the European League Against Rheumatism (EULAR) have emphasized side effects and stressed limited use of glucocorticoids in RA. Biologics have been developed and promoted that are used to replace and taper off low dose prednisone. Yet, glucocorticoids used appropriately can be the cornerstone of effective, safe, and inexpensive treatment of early active rheumatoid arthritis.
可的松于 1948 年由梅奥诊所的 Hench 及其同事引入类风湿关节炎（RA）的治疗中，这导致炎症、功能和幸福感明显改善。早期就明显发现，副作用的发展取决于剂量和使用时间。1950 年可的松上市后，执业医师在没有政府机构、专业组织或制药行业指导的情况下制定了实践模式。医生没有关于使用剂量或使用时间的指导，而如今这些指导是可用的。在过去的 25 年里，对照研究表明，在早期 RA 中低剂量泼尼松具有疗效和安全性。内源性糖皮质激素的昼夜节律为糖皮质激素剂量的时间提供了线索，并且确定了剂量的持续时间。美国风湿病学会（ACR）的指南，特别是欧洲抗风湿病联盟（EULAR）的指南，都强调了副作用，并强调在 RA 中限制使用糖皮质激素。已经开发和推广了生物制剂，用于替代和逐渐减少低剂量泼尼松的使用。然而，糖皮质激素的合理使用可以成为有效、安全和廉价治疗早期活动性类风湿关节炎的基石。
