Steroids An Option to NSAIDS for Treatment of Acute Gout

MedicalResearch.com Interview with:

Professor Timothy H Rainer MD MBBCh Director, Accident & Emergency Medicine Academic Unit The Chinese University of Hong Kong

Prof. Timothy Rainer

Professor Timothy H Rainer  MD MBBCh
Director, Accident & Emergency Medicine Academic Unit
The Chinese University of Hong Kong 

Medical Research: What is the background for this study? What are the main findings?

Prof. Rainer: Gout is a type of arthritis characterised by periodic attacks of acute joint swelling and severe pain, and  often treated with colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs).  Two recent randomized, controlled trials showed that oral prednisolone, a corticosteroid, was as effective as NSAIDs in the treatment of acute gout, but these studies involved small numbers of patients.  The researchers investigatedwhether oral prednisolone was as effective and safe as indomethacin (a NSAID) in a larger sample of patients who had acute gout symptoms and who were seen in the emergency department (ED) setting. Patients in both the prednisolone and indomethacin groups had clinically meaningful decreases in their pain levels during the 2 hours they were observed in the ED as well as during the 14-day follow-up period. Both groups had a similar decrease in pain levels. No major adverse events were reported in either group although there were more minor adverse events in the indomethacin group.

Medical Research: What should clinicians and patients take away from your report?

Prof. Rainer: Physicians could use prednisolone as a first-line option for treatment of patients with acute gout symptoms.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Rainer: As acute gout is a self-limiting disorder, it is possible that the recovery would have occurred in the same time even if no medications were used.  Future studies may investigate whether there is a strong placebo effect.

There have been no direct comparison between oral prednisolone and  colchicine, other NSAIDs or novel uricosuric agents.

There is a need to refine and validate non-invasive clinical tools for differentiating acute gout from other causes of arthritis.

Some patients recovered quicker than others.  Future studies might investigate predictors of response.

Of greater importance might be prevention.  Future studies will look at factors which prevent or reduce the frequency and duration of acute gout attacks. 

Citation:

Rainer TH, Cheng CH, Janssens HJ, Man CY, Tam LS, Choi YF, et al. Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial. Ann Intern Med. [Epub ahead of print 23 February 2016] doi:10.7326/M14-2070

Dr. Timothy Rainer (2016). Steroids An Option to NSAIDS for Treatment of Acute Gout 

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