Irwin, John B, Baldwin, A L, Stenberg, Virgil I · Journal of inflammation research · 2019 · DOI
This study tested whether people with various chronic inflammatory conditions, including ME/CFS, could safely manage their own low-dose hydrocortisone treatment by adjusting it based on symptom flares. Over 2,000 participants achieved an average 76% improvement in symptoms while taking about 12 mg of hydrocortisone daily, and no serious side effects were reported.
ME/CFS is included in this multi-condition analysis examining inflammation-based treatment. If validated, patient-directed low-dose hydrocortisone might offer a non-pharmacist-dependent management strategy for ME/CFS patients experiencing inflammatory symptom flares, particularly during periods of stress or infection.
This study does not prove that hydrocortisone is safe or effective specifically for ME/CFS; the 25 ME/CFS participants were analyzed together with 1,990 others with different disorders, obscuring condition-specific outcomes. The open-label design and absence of a control group prevent determining whether improvements resulted from hydrocortisone, placebo effect, stressor reduction, natural history, or study participation itself. Long-term safety of repeated low-dose hydrocortisone use remains unclear.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Irwin, John B, Baldwin, A L, & Stenberg, Virgil I (2019). General theory of inflammation: patient self-administration of hydrocortisone safely achieves superior control of hydrocortisone-responding disorders by matching dosage with symptom intensity.. Journal of inflammation research. https://doi.org/10.2147/JIR.S195165
BibTeX
@article{mecfsatlas-irwin-2019-general-theory,
author = {Irwin, John B and Baldwin, A L and Stenberg, Virgil I},
title = {General theory of inflammation: patient self-administration of hydrocortisone safely achieves superior control of hydrocortisone-responding disorders by matching dosage with symptom intensity.},
journal = {Journal of inflammation research},
year = {2019},
doi = {10.2147/JIR.S195165},
note = {PubMed: 31354330},
url = {https://www.mecfsatlas.com/evidence/irwin-2019-general-theory},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/irwin-2019-general-theory
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