Acute gout. Steroids as effective as NSAIDS but fewer side effects

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Acute gout: steroids as effective as NSAIDS but fewer side effects  

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. 

References

  1. Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout: A Systematic Review of Randomized Controlled Trials (2017). Click here
  2.  Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study (2017). Click here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.



  
As published in NZ Doctor 31/01/018