Prednisolone was as effective as indomethacin and was associated with fewer adverse effects.
Oral corticosteroids are an alternative to nonsteroidal anti-inflammatory drugs (NSAIDs) for treatment of acute gouty arthritis. However, clinical trials have not compared these two treatments directly. This randomized double-blind trial from Hong Kong included 90 patients (mean age, 65) with acute "goutlike arthritis" (i.e., crystal confirmation or classic podagra without crystal confirmation). Patients received either indomethacin (50 mg 3 times daily for 2 days, then 25 mg 3 times daily for 3 days) or prednisolone (30 mg daily for 5 days).
During 14 days of follow-up, pain resolved at a similar rate in the two groups. However, the incidence of adverse events was significantly higher in the indomethacin group than in the prednisolone group (epigastric pain, 30% vs. 0%; nausea, 26% vs. 9%; dizziness, 19% vs. 5%). Moreover, gastrointestinal bleeding (from endoscopically proven gastric or duodenal ulcers) occurred in five indomethacin recipients but in no prednisolone recipients.
Comment: In this study of patients with gout, prednisolone was as effective as indomethacin and was associated with considerably fewer adverse effects. Although many clinicians reserve oral steroids for patients with contraindications to NSAIDs (e.g., renal insufficiency or peptic ulcer), these authors argue that oral steroids should be considered as first-line therapy. One issue not discussed by the authors is that indomethacin is tolerated less well than many other NSAIDs, which might be as safe and effective as prednisolone.
— Allan S. Brett, MD
Published in Journal Watch General Medicine May 17, 2007
Man CY et al. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: A double-blind, randomized, controlled trial. Ann Emerg Med 2007 May; 49:670-7.