TY - JOUR T1 - Where in the World is Oral Triamcinolone? JF - The Journal of Rheumatology JO - J Rheumatol SP - 1519 LP - 1519 DO - 10.3899/jrheum.101092 VL - 38 IS - 7 AU - LIONEL ROGER Y1 - 2011/07/01 UR - http://www.jrheum.org/content/38/7/1519.1.abstract N2 - To the Editor:Recent reports regarding circadian treatment of rheumatoid arthritis (RA) with a modified form of prednisone indicate this affords significant control of arthritis without affecting the hypothalamic-pituitary axis by maximizing the glucocorticoid’s effect in early morning1. They support previous reports on the beneficial effects of evening triamcinolone (9 alpha-fluoro-11 beta, 16 alpha, 17 alpha, 21-tetrahydroxy-1, 4 pregnandiene-3, 20-dione)2 presented in a 1991 longitudinal study of early therapy in RA.Now that the European League Against Rheumatism intends to assess and set guidelines for this use of modified prednisone, the American College of Rheumatology (ACR) and all drug trial groups in the USA should request from the pharmaceutical industry the immediate reintroduction of oral triamcinolone, a vastly superior disease-modifying glucocorticoid.Although the steroid-sparing concept is the worst and longest-lasting therapeutic tragedy ever suffered on this planet, it still remains publicly at the core of rheumatologic therapeutics. … Address correspondence to Dr. Roger; E-mail: lionelroger{at}hotmail.com ER -