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.