Steroids vs. NSAIDs in Treating Acute Gout

By Jack Cush, MD | 25 July 2018

Gout, the ancient disease of kings is usually treated with the ancient (and costly) drug colchicine, often without consideration of nonsteroidal antiinflammatory drugs (NSAID) or corticosteroids. A recent metanalysis compared the NSAIDS and steroids and showed that both were equipotent in managing the pain of acute gout, but corticosteroids appear had a more favorable safety profile.

The metanalysis revieweed 6 eligible trials, with a total of 817 gout patients treated with either NSAIDs or corticosteroids and had a followup was 15 days (range 4-30).

By day 7, the pain score was low and not significantly different between the two (SMD -0.09; 95% CI -0.26 to 0.08)

There was no difference in the time to disease resolution, or number of supplementary analgesics used.

However, there was a lower risk of indigestion (RR 0.50, 95% CI 0.27-0.92), nausea (RR 0.25, 95% CI 0.11-0.54), and vomiting (RR 0.11, 95% CI 0.02-0.56) with corticosteroid therapy.

Corticosteroids may be preferred over NSAIDs in managing acute gout as they have less GI adverse events in RCTs.

Disclosures:

The author has no conflicts of interest to disclose related to this subject

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