Low- or Micro-Dose Hydrocortisone Therapy
The proponents of this therapy lump fibromyalgia in with autoimmune diseases, such as rheumatoid arthritis, in which joint swelling is obvious. While there are reproducible reports of abnormal immune function in fibromyalgia, such as increased production of cytokines, systemic inflammation is not present. However, you may still wonder: “Is there a subtle inflammatory process in fibromyalgia that escapes detection?”
Years ago, fibromyalgia was called fibrositis because the pain in the muscles was believed to be due to inflammation. While fibromyalgia is no longer viewed as “fibrositis” or an inflammatory disease, a treatment trial published in 1985 serves to clarify this issue.1 Twenty patients diagnosed with “fibrositis” were given either 15 mg/day of Prednisone or a placebo for 14 days, then their therapy was switched for an additional 14 days. In essence, the patients served as their own controls using a drug that fights inflammation. Prednisone is a corticosteroid, just like hydrocortisone, and it works in the body to relieve inflammation. Yet, the “fibrositis” patients did not improve at all on the Prednisone therapy. In fact, many patients got worse.
A separate study using low-dose hydrocortisone therapy in 60 patients diagnosed with chronic fatigue syndrome, which overlaps substantially with fibromyalgia, showed a mild but not statistically significant improvement in symptoms.2 The dose of hydrocortisone used in this study was equivalent to only 6 mg/day of Prednisone (definitely a low dose). It was hypothesized that the hydrocortisone, the synthetic version of the cortisol hormone produced by the adrenal glands, would augment the function of the adrenal glands. In fact, the participants were given the hydrocortisone in small divided doses throughout the day to simulate the secretion of cortisol. Unfortunately, even at such a low dose for only 12 weeks, the hydrocortisone produced serious immune suppression in 20% of the participants. Immune suppression is a serious concern because it leaves people vulnerable to infection (e.g., they don’t have an adequate immune system to fend off infections).
Despite these two negative studies documenting the ineffectiveness of low-dose of corticosteroids to relieve the symptoms of fibromyalgia or chronic fatigue syndrome, this treatment is sometimes endorsed for fibromyalgia. The proponents of this therapy reference many medical journal articles on inflammatory diseases, such as rheumatoid arthritis, although none of the articles pertain to fibromyalgia. Individualized protocols and monitoring are supposedly used, which could make a very ill person feel quite special. However, the cost is over $2,000 per month and there is no published evidence that low-dose hydrocortisone therapy works for relieving the symptoms of fibromyalgia.
1. Clark S, et al. J Rheumatol 12(5):980-983, 1985.
2. McKenzie R, et al. JAMA 280(12):1061-1066, 1998.