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Steroids vs. NSAIDs in Treating Acute Gout

Jul 25, 2018 12:31 pm

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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