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Published on 30 May 2008

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Prednisolone should be first for gout

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The corticosteroid drug prednisolone is as effective at treating gout arthritis as naproxen, a conventional treatment. Prednisolone could thus be used to treat the condition in place of conventional treatments that can cause gastrointestinal, renal, and cardiovascular complications. These are the conclusions of authors of an article in this week’s edition of The Lancet.

The conventional drugs for arthritis are colchicine and non-steroidal anti-inflammatory drugs (NSAIDs).

Colchicine is the most longstanding treatment, but its use has declined because of its narrow therapeutic window, its disadvantage in the case of renal failure and the availability of NSAIDs. NSAIDs are now the first choice of drug treatment, despite their gastrointestinal and cardiovascular risks, which are often seen in gout patients.

In a randomised clinical trial, 120 primary-care patients with gout confirmed by presence of monosodium urate crystals were assigned to receive either prednisolone (35mg once a day, 60 patients), or naproxen (500mg twice a day, 60 patients).

The researchers measured pain using a visual analogue scale from 0mm (absence of pain) to 100mm (most severe pain ever experienced).

They found after 90 hours the reduction in the pain score was between 62 and 17 mm for prednisolone, and 59 to 13mm for naproxen, in almost the same pattern, suggesting equivalence. Adverse effects were similar between groups, minor, and resolved by three week follow-up.

The authors conclude that prednisolone was, in this trial, clinically equivalent to naproxen in the treatment of gout. They say: “In addition to better safety, the direct drug costs would also be less if systemic corticosteroids, such as prednisolone, were the first-line drug choice. In the context of economic benefits, the additional costs of gastroprotective drugs added to NSAID-treatment, should also be taken into account. In conclusion, the present study provides a strong argument to consider prednisolone as a first treatment option in patients with gout.”

The Lancet



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