Cortisone for Rheumatoid Arthritis

The adrenal glands sit on top of the kidneys, and for a long time their function was unknown, beyond the observation that animals deprived of them developed deficiency diseases and died. In the mid-1930s Edward Kendall, a biochemist at the Mayo Clinic, and Tadeus Reichstein at the University of Basel isolated a series of related hormones from the adrenal cortex. One of them, called compound E, is cortisone.

Making cortisone in quantity took years of struggle between researchers and drug companies, and a synthesis that allowed commercial production came only in 1948. Later that year Philip Hench of the Mayo Clinic, with his colleagues Slocumb and Polley, gave compound E to a volunteer patient with rheumatoid arthritis. The improvement was dramatic, and a larger clinical trial gave similar results.

Hench, Kendall and their co-workers published the results in April 1949 in the Proceedings of the Staff Meetings of the Mayo Clinic. In 1950 Kendall, Reichstein and Hench shared the Nobel Prize in Physiology or Medicine for their discoveries about the hormones of the adrenal cortex, their structure and their biological effects. By then cortisone preparations were being used for rheumatoid arthritis and other inflammatory conditions.

The drug's side effects soon became apparent. On 10 September 1955 the medical journalist Berton Roueché published Ten Feet Tall in The New Yorker, the case of a teacher who became manic and psychotic after taking a large dose of cortisone for periarteritis nodosa; the psychosis resolved after he was readmitted and his medication adjusted. The 1956 film Bigger Than Life, directed by Nicholas Ray, used cortisone as its plot device.