Are glucocorticoids equivalent to NSAIDs for the treatment of gout flares?

Abstract

NSAIDs are the current mainstay of treatment for gout flares, despite being associated with an increased risk of gastrointestinal bleeding and cardiovascular events. Janssens et al. conducted a randomized, double-blind, equivalence clinical trial to determine whether the glucocorticoid prednisolone can be used as an alternative to NSAIDs in this setting. Patients referred from primary care community clinics with monosodium urate crystal-proven acute gout flares (n =120) underwent treatment with once-daily oral prednisolone 35 mg or twice-daily oral naproxen 500 mg for 5 days. The results revealed a nonsignificant difference between the two groups, both in the primary outcome measure of pain reduction and in the secondary outcomes of disability related to the affected joint and walking, suggesting equivalence between the two agents. This study helps to position oral glucocorticoids as effective and safe alternatives in the management of acute gout flares. Future studies should address the treatment of acute gout in elderly populations and in those with multiple comorbidities.