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An emergency department based study evaluated the efficacy and safety of oral prednisolone versus indomethacin in 416 patients with acute gout in a multicenter, double-blind, randomized trial.
There were 376 patients who completed the 14-day study, and the primary outcome was pain by 100 mm visual analogue scale.
Equivalent and clinically significant within-group reductions in mean pain score were observed with indomethacin and prednisolone acutely in the emergency department (approximately 10 mm improvement at rest and 20 mm improvement with activity) and later (from days 1 to 14) patients improved approximately 25 mm [rest] and 45 mm [activity].
No major adverse events occurred during the study. In the emergency department, indomethacin group had more minor adverse events than those in the prednisolone group (19% vs. 6%; P < 0.001).
Oral prednisolone and indomethacin had similar analgesic effectiveness among patients with acute gout. Prednisolone is an effective and safe first-line option for treatment of acute gout.