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March 17, 1951


Author Affiliations

Beth-E1 Hospital, Brooklyn.

JAMA. 1951;145(11):842. doi:10.1001/jama.1951.02920290068022

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To the Editor:—  The purpose of this communication is to report a small series of cases of rheumatoid arthritis treated with insulin. It has been demonstrated that insulin-induced hypoglycemia will produce a fall in circulating eosinophils and increased urinary uric acid excretion in the presence of responsive adrenal cortical tissue. Similar effects are found following the administration of epinephrine. Increased urinary uric acid excretion and fall in circulating eosinophils are indexes of increased adrenocortical activity. Insulin and epinephrine are believed to act on the anterior hypothalamus, from which the anterior pituitary is stimulated. This, in turn, produces adrenocortical secretion (Hume, D., Jr.: J. Clin. Investigation28:790, 1949). These pathways are readily exhausted by repeated stimulation.The beneficial effects of 17-hydroxy-11-dehydrocorticosterone (Kendalls' compound E; cortisone) and of pituitary adrenocorticotropic hormone (ACTH) on rheumatoid arthritis has led us to investigate the therapeutic value of insulin in this disease. Nine cases of

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