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Oral Prednisolone in the Treatment of Acute Gout FREE

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The full report is titled “Oral Prednisolone in the Treatment of Acute Gout. A Pragmatic, Multicenter, Double-Blind, Randomized Trial.” The authors are T.H. Rainer, C.H. Cheng, H.J.E.M. Janssens, C.Y. Man, L.S. Tam, Y.F. Choi, W.H. Yau, K.H. Lee, and C.A. Graham.

This article was published at www.annals.org on 23 February 2016.


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Ann Intern Med. 2016;164(7):I-30. doi:10.7326/P16-9011
© 2016 American College of Physicians
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23 22016.

What is the problem and what is known about it so far?

Gout is a type of inflammatory arthritis in which patients have periodic attacks of acute joint swelling and severe pain. Acute gout is often treated with colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs). Two recent randomized, controlled trials showed that oral prednisolone, a corticosteroid, was as effective as NSAIDs in the treatment of acute gout, but these studies involved small numbers of patients.

Why did the researchers do this particular study?

The researchers wanted to see whether oral prednisolone was as effective and safe as indomethacin (an NSAID) in a large sample of patients who had acute gout symptoms and were seen in the emergency department (ED) setting.

Who was studied?

416 adult patients aged 18 years or older who presented with symptoms of acute gout to 4 EDs in Hong Kong.

How was the study done?

The patients were randomly assigned to receive either oral prednisolone or indomethacin for 5 days. They took the first dose in the ED and had clinical assessments, which included measurement of pain scores and examination of the affected joint, every 30 minutes for 2 hours. The patients then completed a trial diary every day for 14 days, in which they recorded their pain level and whether they had pain with movement of the joint. The researchers also collected information on whether the patients had any adverse events caused by the study medications and whether they took all of the medications as prescribed.

What did the researchers find?

Patients in both the prednisolone and indomethacin groups had clinically meaningful decreases in their pain levels during the 2 hours they were observed in the ED as well as during the 14-day follow-up period. Both groups had a similar decrease in pain levels. No major adverse events were reported in either group.

What were the limitations of the study?

Research assistants were only available to screen and enroll patients for the study during daytime hours, Monday through Friday. They may have missed enrolling patients with more acute or severe gout symptoms who were seen during the evening hours or on weekends.

What are the implications of the study?

Physicians could use prednisolone as a first-line option for treatment of patients with acute gout symptoms.

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