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Corticosteroids could be considered first-line treatment for acute gout
due to their better safety profile than NSAIDs.
Gout is
counted among the most prevalent diseases which fluctuate 0.1% to 10% in
different geographical regions. For acute gout treatment, the drugs which used
most commonly are nonsteroidal anti-inflammatory drugs (NSAID). Many more drug
modalities such as corticosteroid to tackle gout also explored recently.
Christy Amanda Billy and colleagues conducted a randomized controlled trial
(RCT) meta-analysis to analyze acute gout management by NSAID versus
corticosteroid therapy. For analysis EMBASE, CENTRAL and MEDLINE were explored
systematically by August 2016. The pain, joint swelling, tenderness, bleeding,
erythema, response to therapy, response to treatment, time to resolution,
quality of life, supplementary analgesics, and adverse events were taken as
outcomes. The GRADE (Grading of Recommendations Assessment, Development, and
Evaluation) system was used to review evidence quality.
A total of six suitable trails were determined which involved 817 patients. Overall 15 days were taken for mean study follow up. The risks of bias were low during the meta-analysis. The corticosteroid had exhibited no identical effects on pain score at seven days as compared to nonsteroidal anti-inflammatory drugs. The small to moderate evidence was noticed.
Further, no evidence was seen of gastrointestinal bleeding risk. For different
responses to therapy on pain at < 7 days and ≥ seven days, some additional
analgesics used, or time to disease resolution no evidence was seen. The
corticosteroid therapy showed a lower risk of nausea, vomiting, and
indigestion.
The whole analysis exhibits no evidence that NSAID and corticosteroids exhibit
different efficacy for acute gout management. However, corticosteroids showed
high favourable safety profile for specified adverse events analyzed in the
existing randomized controlled trial.
J Rheumatol. 2017 Aug 1. pii: jrheum.170137
Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout: A Systematic Review of Randomized Controlled Trials.
Christy Amanda Billy et al.
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