We have discussed previously the hypothesis that corticoids actively intervene in the synthesis of an entire group of substances in the organism. The energetic formation between C11 and C21 of these corticoids would act as a mold or template to attract and keep various radicals in special reciprocal position, thus favoring, as a second step, the synthesis of new substances. These substances would vary according to the energetic formation of the corticoid. In one group, which could be called the "gluco" group, we identified glucose, glucuronic acid, glucosamine, galactosamine, glucosamine acid, galactosaminic acid, and some other uronic acids. Even ascorbic acid could be related to such a synthesis mechanism.

We investigated some of these substances, particularly in relation to the therapeutic properties of corticoids. In 1951, we chose glucosamine as a substance closely corresponding to the template of cortisone. Glucosamine treatment was used in patients with pemphigus, rheumatoid arthritis, psoriasis, ocular condition and allergy. The following cases illustrate the results obtained.

Mr. H. S., 46 years old, had generalized psoriasis. In the last twelve years, the lesions had progressed continuously to cover more than 75% of his skin. Local treatment had had little effect. Cortisone injections cleared the skin in two weeks but not completely. With cessation of treatment, the condition returned. The patient remained without treatment for a few months before beginning our treatment: 5 cc. injections of glucosamine 10% solution administered daily. Changes were seen in 3 days, with the lesions becoming paler and less scabby. With two injections daily, the skin was almost entirely normal in about 10 days, only a few lesions remaining. Continuation of the treatment for another week did not make these disappear. Upon cessation of treatment, the lesions regressed to their previous dimensions. In a second course of treatment, with two daily injections of 5 cc. of a 10% solution of glucosamine in saline, the lesions cleared but reappeared when treatment was discontinued.

We also treated a series of cases of rheumatoid arthritis and found that subjects, who had previously responded well to cortisone, also responded to glucosamine.

Mrs. B. B. had rheumatoid arthritis of the left knee and both hands. Pain and swelling were severe. The patient had responded fairly well to cortisone, but due to retention of water, this treatment was discontinued. In less than 10 days, the arthritis returned. The patient was given glucosamine injections. At first, 5 cc. of the 10% solution in saline was injected once a day. Later, 3 injections daily were used. The symptoms, which had decreased with the lower doses, were fully controlled by the 3 daily injections. Pain and swelling fully disappeared. Moon face was not observed. The treatment was continued with 2 injections daily and, after one week, one injection daily. With this dose, pain and swelling returned. Resumption of 3 injections a day controlled them again. The treatment was discontinued because of the apprehension of the patient over receiving 3 injections daily of 5 cc. each. A mixed treatment with a lower dose of cortisone and one injection of glucosamine daily was continued with satisfactory results for a few weeks, after which the patient stopped her visits.

We treated cases of rheumatoid arthritis with oral glucosamine with fair to good results. Four grams of glucosamine a day appeared to be the minimum requirement. Good results could be seen in some cases after doses of 5 to 10 grams daily. These results were confirmed by B. Welt who, following his research, used the same preparation of glucosamine on a series of 15 patients bedridden with arthritis at the Greenpoint Hospital in Brooklyn, New York. Subjective and objective improvement occurred in patients with rheumatoid arthritis while no changes were seen for those with osteoarthritis.

For more than one year, Welt has treated a case of pemphigus with injections of glucosamine and has been able to prevent the appearance of new lesions.

In a few cases of iridocyclitis, treatment with glucosamine (2 injections of 5 cc. of the 10% solution daily) healed the lesions in two or three days.

Galactosamine produced results almost similar to those of glucosamine. Still better results were seen with glucosamine acid, used in the same doses as glucosamine. Some strikingly good results in several cases of arthritis were obtained with gluconic acid administered orally in doses of a few grams a day (four tablespoons of a 25% solution).