Regarding Brian Senior's enquiry about a pill from Pakistan for
arthritis, this almost certainly contains a synthetic glucucorticoid.
I am not aware of any natural substance which provides effective
treatment. We have analysed several of these pills and they most
usually contain prednisolone. Rather than look for a specific
synthetic glucocorticoid in the pill, which can be tricky for some
unless more than one method is tried, a good general purpose screen is
to look for suppression of endogenous cortisol in the patient. Serum
cortisol assay would of course be subject to interference by
prednisolone, but cortisol metabolites by GC profiling in a 24h urine
would be definitive. Further, if the pill does contain prednisolone,
the metabolites can also be detected in urine at the same time.
Norman Taylor
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