THE QUESTION of whether or not adrenal corticosteroid hormones cause or aggravate peptic ulcer remains unsettled. Elsewhere in this issue of the Archives is a study which reports that corticosteroid hormones in the doses commonly used in the treatment of patients with rheumatoid arthritis (15 mg or less of prednisone a day) do not increase the incidence of peptic ulceration. This study suggests that the increase of peptic ulceration in patients with rheumatoid arthritis is a function of the disease and not the therapy.
Will such a study encourage indiscriminate use of steroid hormones in patients with rheumatoid arthritis or other chronic painful musculoskeletal disease? The array of problems that arise from the prolonged use of corticosteroids is so impressive that their absolution as a cause of peptic ulcer is relatively trivial. The physician who has seen a patient with overwhelming sepsis, collapsed vertebrae, or severe muscle atrophy, or who