DISPOSITION OF INTRA-ARTICULARLY INJECTED HYDROCORTISONE ACETATE, HYDROCORTISONE AND CORTISONE ACETATE IN ARTHRITIS. I. CONCENTRATIONS IN SYNOVIAL FLUID AND CELLS*

INTRA-ARTICULAR injection of hydrocortisone acetate has been demonstrated by Hollander, Brown, Jessar and Brown (1) to produce prompt alleviation of pain and diminution of synovial swelling and effusion with a fall toward normal intra-articular temperature in nearly 90 per cent of patients with rheumatoid arthritis. In contrast to this, cortisone acetate in similar or even larger doses is far less effective, with only about 25 per cent of the patients showing even partial improvement after intra-articular injection. The reason for this difference in local anti-inflammatory action is obscure. Original assumptions that the difference was due to lower solubility of hydrocortisone acetate have proved incorrect, since more soluble forms of hydrocortisone have proved as effective as the acetate, and less soluble esters of cortisone no more effective than the cortisone acetate (1). These studies were undertaken to determine whether there was a significant difference in the rates of change in concentration of the hormones in the synovial fluid, and possible differences in concentrations in the synovial fluid cells and the structures of the joint itself.