Erik Matteson MD, MPH from Mayo Clinic gave us a very good historical review of the isolation of cortisone from adrenal glands and the initial use for Addison’s disease then the use in patients with RA. He highlighted not only the science but the personalities of the key players: Phillip Hench MD, head of rheumatology, Nick Kendall PhD chemist, Howard Polley MD, clinical rheumatologist and Charles Slocumb, clinical rheumatologist. The dramatic clinical response to cortisone was truly amazing and led to the awarding of the Nobel Prize to Kendall and Hench. Of course it was in short order that they understood many of the side effects and the fact that the improvement went away when the cortisone was tapered. Apparently, this disappointment after the high expectations of a “cure” took its toll on Hench who in his later years had some signs of depression. This is probably the most important clinical discovery in modern rheumatology and of course we still use boat loads of prednisone for various inflammatory diseases 70+ years later. I was fortunate to have Howard Polley as a volunteer visiting faculty when I was a fellow at Indiana University. He was a substantial influence on my career and taught me to be one of the more stingy prednisone prescribers amongst my faculty colleagues and friends. If you could not attend the lecture by Dr Matteson at the ACR I would highly recommend reading the book “The Quest for Cortisone” by Thom Rooke which is a very good account of this important story. A couple of years ago I reviewed this book for RheumNow and would make it mandatory reading for all rheum fellows if I was still a fellowship director!
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