A 5-day course of oral prednisolone is a reasonable alternative to NSAIDs for treating patients with acute gouty arthritis.
In a recent study of patients with acute gout, oral prednisolone was as effective as — and better tolerated than — indomethacin (JW May 17 2007). Those findings suggested the following question: How does prednisolone compare with nonsteroidal anti-inflammatory drugs that might be less potent, but also less toxic, than indomethacin?
Dutch researchers randomized 120 patients with acute gouty arthritis and no contraindications to NSAIDs to receive either oral prednisolone (35 mg daily) or naproxen (500 mg twice daily) for 5 days. All patients were referred by primary care physicians within 24 hours of initial presentation, and monosodium urate crystals were identified in synovial fluid from a symptomatic joint in each patient. Prednisolone and naproxen provided equal pain relief, according to pain scores recorded on a visual analog scale at 12-hour intervals. Adverse effects were minimal, and incidences were similar in the two groups. All patients reported full symptom relief at 3-week follow-up.
Comment: Recruitment of patients from primary care offices makes this study relevant for nonspecialists, although, in routine practice, the clinical diagnosis of gout is not always confirmed by joint aspiration. A brief course of prednisolone is a reasonable alternative to an NSAID for patients with acute gout, particularly those for whom NSAIDs might pose a safety risk.
— Bruce Soloway, MD
Published in Journal Watch General Medicine June 17, 2008
Janssens HJEM et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: A double-blind, randomised equivalence trial. Lancet 2008 May 31; 371:1854.