Background: The two medicines recommended by NICE for acute gout are NSAIDs and colchicine. The main problem with NSAIDs is that they are contraindicated in many patient groups - the elderly, those with bleeding disorders, stomach ulcers, renal insufficiency and liver dysfunction to name a few. Colchicine is not always a great choice either, frequently causing diarrhoea. I've had patients come into the room saying, "Don't prescribe that medicine that gives me the s**ts!"... Is there another option?

 

 

Billy CA, Lim RT, Ruospo M, et al. Corticosteroid or nonsteroidal antiinflammatory drugs for the treatment of acute gout: a systematic review of randomized controlled trials. J Rheumatol. 2018;45:128-136

 

 

The paper: A systematic review that found 6 RCTs comparing steroid to NSAIDs for the treatment of acute gout. These trials covered a total of 817 patients. They found no significant difference between the two drugs in terms of pain relief, time to resolution of pain, or requirement for additional analgesics. There was also no difference in rates of GI bleeding, although nausea, vomiting and indigestion were commoner in the NSAID group. Hyperglycaemia was commoner in the steroid group.

 

 

The bottom line: This review found no significant difference between steroids and NSAIDs for acute gout, though they did see more side effects with NSAIDs. Steroids seem to be a reasonable treatment choice, unless your patient is diabetic.

 

 

Note: the most common dosing regimen for steroids in the studies was oral prednisolone 30mg daily for 5 days

 

 

Expert commentary:"Please also be aware that prednisolone is a risk factor for and can trigger peptic ulcers."

 

(Dr Robert Tan, ED consultant)