A systematic review found 6 studies comparing oral corticosteroids versus NSAIDS.1 There was no difference in efficacy but there were significant differences in adverse effects. There was no difference in risks of gastrointestinal bleeding [relative risk (RR) 0.09, 95% CI 0.01-1.67]. 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.
Caution is needed with short courses of corticosteroids, with rare but statistically significant increases in fractures, sepsis, and thrombosis.2
In acute gout, ruling out septic arthritis is essential and the patient’s vital signs need to be normal before prescribing oral corticosteroids.