Gout: Difference between revisions
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|+ Comparison of NSAID and steroids for acute gout | |+ Comparison of NSAID and steroids for acute gout | ||
! rowspan="2"| !! Patients!!colspan="2"|Interventions !! rowspan="2"|Results | ! rowspan="2"| !!rowspan="2"| Patients!!colspan="2"|Interventions !! rowspan="2"|Results | ||
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! Steroid||NSAID | ! Steroid||NSAID | ||
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| Janssens et al 2008<ref name="pmid18514729">{{cite journal |author=Janssens HJ, Janssen M, van de Lisdonk EH, van Riel PL, van Weel C |title=Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial |journal=Lancet |volume=371 |issue=9627 |pages=1854–60 |year=2008 |month=May |pmid=18514729 |doi=10.1016/S0140-6736(08)60799-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60799-0 |issn=}}</ref> | | Janssens et al 2008<ref name="pmid18514729">{{cite journal |author=Janssens HJ, Janssen M, van de Lisdonk EH, van Riel PL, van Weel C |title=Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial |journal=Lancet |volume=371 |issue=9627 |pages=1854–60 |year=2008 |month=May |pmid=18514729 |doi=10.1016/S0140-6736(08)60799-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60799-0 |issn=}}</ref> | ||
||120 total patients with [[uric acid]] crystals on [[arthrocentesis]] | ||120 total patients with [[uric acid]] crystals on [[arthrocentesis]] | ||
||[[Prednisolone]] 35 mg once daily | ||[[Prednisolone]] 35 mg once daily for 5 days | ||
||[[Naproxen]] 500 mg twice daily | ||[[Naproxen]] 500 mg twice daily for 5 days | ||
||NSAID tended to be better | ||NSAID tended to be better | ||
|- | |- | ||
| Man et al 2007<ref name="pmid17276548">{{cite journal |author=Man CY, Cheung IT, Cameron PA, Rainer TH |title=Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial |journal=Annals of emergency medicine |volume=49 |issue=5 |pages=670–7 |year=2007 |pmid=17276548 |doi=10.1016/j.annemergmed.2006.11.014}}</ref> | | Man et al 2007<ref name="pmid17276548">{{cite journal |author=Man CY, Cheung IT, Cameron PA, Rainer TH |title=Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial |journal=Annals of emergency medicine |volume=49 |issue=5 |pages=670–7 |year=2007 |pmid=17276548 |doi=10.1016/j.annemergmed.2006.11.014}}</ref> | ||
||90 total patients with clinical diagnosis of gout† | ||90 total patients with clinical diagnosis of gout† | ||
||Initially [[prednisolone]] 30 mg<br/>Followed by prednisolone 30 mg daily for 5 days | ||Initially [[prednisolone]] 30 mg<br/>Followed by prednisolone 30 mg daily for 5 days and as needed [[acetaminophen]] | ||
||Initially [[diclofenac]] 75 mg with [[indomethacin]] 50 mg<br/>Followed by indomethacin 50 mg every 8 hrs for 2 days then 25 mg every 8 hrs for 3 days | ||Initially [[diclofenac]] 75 mg with [[indomethacin]] 50 mg<br/>Followed by indomethacin 50 mg every 8 hrs for 2 days then 25 mg every 8 hrs for 3 days and as needed [[acetaminophen]]. | ||
||Steroids faster reduction in pain | ||Steroids faster reduction in pain.<br/>Steroids used more [[acetaminophen]].<br/>More adverse effects from [[indomethacin]]. | ||
|- | |- | ||
|colspan="5"|Notes:<br/> | |colspan="5"|Notes:<br/> | ||
Revision as of 09:34, 25 January 2009
In medicine, gout is a "hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi."[1]
Treatment
A randomized controlled trial found that patients who used ice packs had better relief of pain with no negative side effects.[2]
| Patients | Interventions | Results | ||
|---|---|---|---|---|
| Steroid | NSAID | |||
| Janssens et al 2008[3] | 120 total patients with uric acid crystals on arthrocentesis | Prednisolone 35 mg once daily for 5 days | Naproxen 500 mg twice daily for 5 days | NSAID tended to be better |
| Man et al 2007[4] | 90 total patients with clinical diagnosis of gout† | Initially prednisolone 30 mg Followed by prednisolone 30 mg daily for 5 days and as needed acetaminophen |
Initially diclofenac 75 mg with indomethacin 50 mg Followed by indomethacin 50 mg every 8 hrs for 2 days then 25 mg every 8 hrs for 3 days and as needed acetaminophen. |
Steroids faster reduction in pain. Steroids used more acetaminophen. More adverse effects from indomethacin. |
| Notes: † Clinical diagnosis of gout was "pain and warmth in a joint, and presented within 3 days of the onset of pain and also had 1 or more of the following: metatarsal-phalangeal joint involvement; knee or ankle joint involvement and aspirate containing crystals; or typical gouty arthritis, with either gouty tophi present or previous joint aspiration confirming the diagnosis of gout." Seven patients allowed arthrocentesis and all were positive for gout. | ||||
Randomized controlled trials find similar benefit from non-steroidal anti-inflammatory agents and oral glucocorticoids. In the first trial, less adverse drug reactions occurred in the glucocorticoids group.[4] In the non-steroidal anti-inflammatory agents group, each patient initially received diclofenac (75 mg) intramuscularly, indomethacin 50 mg orally, and acetaminophen 1 g orally. The patient was received a 5-days of indomethacin (50 mg orally every 8 hours for 2 days, followed by indomethacin 25 mg every 8 hours for 3 days), and acetaminophen 1 g every 6 hours as needed. The glucocorticoids patients received prednisolone 30 mg orally, and acetaminophen 1 g orally. The patient was then given prednisolone 30 mg orally once per day for five days.
In the second randomized controlled trial equal effect resulted from prednisolone 35 mg orally per day or naproxen 500 mg orally per day.[3]
Colchicine
Colchicine is better than placebo according to a systematic review by the Cochrane Collaboration[5] that found a single randomized controlled trial[6].
Prognosis
Acute flares
Without treatment, one third of flares improve within 2 days.[6]
Prevention
Diet
Avoiding products with high fructose such as sugary soft drinks (sweetened with high fructose corn syrup), and other high-fructose products, such as fruit juice, apples, and oranges may help.[7]
Medications
Xanthine oxidase inhibitors
Allopurinol can reduce frequency of attacks. However, when allopurinol is started, colchicine 0.6 mg twice daily should also be used. In a randomized controlled trial, co-treatment with colchicine 0.6 mg twice daily while allopurinol was tapered up from 100 mg/day until 3 months after the serum urate concentration < 6.5 mg/dl, reduced flares of gout from 77% in the placebo broup to 33% with colchicine prophylaxis. Most of these patients had tophi.[8]
Allopurinol should be increased as possible to achieve a goal serum urate of <6 mg/dl (360 micromoles/liter).[9]
Febuxostat, a non-purine inhibitor, is equally effective as allopurinol when compared in a randomized controlled trial.[10]
Uricosuric agents
References
- ↑ Anonymous (2024), Gout (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Schlesinger N, Detry MA, Holland BK, et al (2002). "Local ice therapy during bouts of acute gouty arthritis". J. Rheumatol. 29 (2): 331–4. PMID 11838852. [e]
- ↑ 3.0 3.1 Janssens HJ, Janssen M, van de Lisdonk EH, van Riel PL, van Weel C (May 2008). "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial". Lancet 371 (9627): 1854–60. DOI:10.1016/S0140-6736(08)60799-0. PMID 18514729. Research Blogging.
- ↑ 4.0 4.1 Man CY, Cheung IT, Cameron PA, Rainer TH (2007). "Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial". Annals of emergency medicine 49 (5): 670–7. DOI:10.1016/j.annemergmed.2006.11.014. PMID 17276548. Research Blogging.
- ↑ Schlesinger N, Schumacher R, Catton M, Maxwell L (2006). "Colchicine for acute gout". Cochrane Database Syst Rev (4): CD006190. DOI:10.1002/14651858.CD006190. PMID 17054279. Research Blogging.
- ↑ 6.0 6.1 Ahern MJ, Reid C, Gordon TP, McCredie M, Brooks PM, Jones M (June 1987). "Does colchicine work? The results of the first controlled study in acute gout". Aust N Z J Med 17 (3): 301–4. DOI:10.1111/j.1445-5994.1987.tb01232.x. PMID 3314832. Research Blogging.
- ↑ Hyon K Choi and Gary Curhan, “Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study,” BMJ (January 31, 2008): bmj.39449.819271.BE.
- ↑ Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA (2004). "Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis". J. Rheumatol. 31 (12): 2429–32. PMID 15570646. [e]
- ↑ Perez-Ruiz F, Lioté F (2007). "Lowering serum uric acid levels: What is the optimal target for improving clinical outcomes in gout?". Arthritis Rheum. 57 (7): 1324–8. DOI:10.1002/art.23007. PMID 17907217. Research Blogging.
- ↑ Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA, Streit J, Joseph-Ridge N.Febuxostat compared with allopurinol in patients with hyperuricemia and gout.N Engl J Med. 2005 Dec 8;353(23):2450-61. PMID 16339094