Prednisolone for Acute Gout Provides Similar Analgesia as Indomethicin

HealthDay News – For patients with acute gout, prednisolone has similar analgesic effectiveness to indomethacin, according to a study published online Feb. 23 in the Annals of Internal Medicine.¹

Timothy Hudson Rainer, MD, from the Chinese University of Hong Kong, and colleagues compared the effectiveness and safety of oral prednisolone versus oral indomethacin in patients presenting to emergency departments with acute gout. A total of 376 patients, aged 18 years or older, were randomized to receive either indomethacin or prednisolone. Patient outcomes were assessed during the first two hours in the emergency department and from days one to 14.

The researchers observed equivalent and clinically significant within-group reductions in the mean pain score with indomethacin and prednisolone in the emergency department and from days one to 14. During the study there were no major adverse events. 

Patients in the indomethacin group had more minor adverse events during the emergency department phase than patients in the prednisolone group (19% vs 6%; P < 0.001). Thirty-seven percent of patients in each group had minor adverse events during days one to 14.

“Oral prednisolone and indomethacin had similar analgesic effectiveness among patients with acute gout,” the authors write. “Prednisolone is an effective and safe first-line option for treatment of acute gout.”

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Summary and Clinical Applicability

Acute gouty arthritis is often treated with NSAIDs, but recent studies have suggested that treatments with oral glucocorticoids provide similar levels of analgesia as compared to treatment with certain NSAIDs. In this study, oral prednisolone had similar analgesic effectiveness as compared to indomethicin among patients with acute gout. Prednisolone treatment was also associated with fewer adverse effects. This study was limited by the reliance on clinical criteria to diagnose gout, as opposed to diagnosis based on direct joint aspirate analysis. 

This finding suggests that prednisolone can be used to treat acute gout pain, especially in patients who have contraindications to NSAID use, like renal failure or severe gastrointestinal disease. 

It is important to note that rebound attacks can be occur once glucocorticoids are withdrawn, thus slow tapering of the glucocorticoid dose, with extension of dose course has been advised in certain patients.²  

Summary and clinical applicability statement by Corinna Panlilio Sison, MD

Reference

1. Ranier TH, Cheng CH, Hein JJ, et al. Oral prednisolone is more cost-effective than oral indomethacin for treating patients with acute gout-like arthritis. Eur J Emerg Med. 2009 Oct;16(5):261-6.

2.Taylor TH, Mecchella JN, Larson RJ, Kerin KD, Mackenzie TA. Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial. Am J Med. 2012;125(11):1126-1134.e7.