Prescribing Advice for GPs

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Steroids effective for gout

The Lancet has published the results of a study that aimed to assess the efficacy of prednisolone compared to naproxen in treating gout.

The rationale for the study was that non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen have gastrointestinal, cardiovascular and renal side effects and colchicine has gastrointestinal side effects. Oral corticosteroids may therefore be a suitable alternative to drugs.

120 patients were recruited to the study and randomly assigned to five days treatment with 35mg of prednisolone daily or 500mg of naproxen twice daily. Efficacy was assessed using a 100mm visual analogue scale.

Pain score was reduced after 90 hours in both groups, by 44.7mm in the prednisolone group and by 46.0mm in the naproxen group. The difference was 1.3mm (95% CI -9.8 - 7.1) and not significant. Adverse events were similar in the two groups, were minor and resolved by 3 week follow up.

The authors conclude that, "oral prednisolone and naproxen are equally effective in the initial treatment of gout arthritis over 4 days". The study has invited some criticism in an accompanying editorial; it is one small study in a selected population. This editorial recommends that these results need to be repeated in larger trials.

Action: Despite the limitations in this study clinicians may consider using oral prednisolone to treat acute gout in patients who are at high risk of cardiovascular, gastrointestinal or renal disease.

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