Title: Comparison of Oral Prednisone/Paracetamol Combination Therapy in Treatment of Acute Goutlike Arthritis: A Double-Blind Randomized Controlled Trial
Authors: CY Man, ITF Cheung, PA Cameron, TH Rainer
Source: Annals of Emergency Medicine; 2007 49(5): 670-677.
PODIATRIC RELEVANCE:
Acute gout is a common condition treated by podiatric physicians in both the office and hospital settings. The current protocol for treatment of acute goutlike arthritis consists of non-steroid anti-inflammatory drugs (NSAIDS) and colchicine. NSAIDS have been associated with adverse events and are contraindicated in patients with renal failure, a history of gastrointestinal (GI) bleeds, and/or ulceration. Prednisone has been recommended for the treatment of gout, but significant studies have not been performed comparing the two forms of treatment.
METHODS:
This study was a double-blind, randomized, control trial taking place in the emergency department (ED) of Wales Hospital, in the New Territories of Hong Kong. The study took place from February 1, 2003 to June 30, 2004 randomizing a total 90 patients comparing oral prednisolone/acetaminophen to indomethacin/acetaminophen for the treatment of clinically diagnosed acute goutlike arthritis. Treatment groups were assessed on scheduled intervals utilizing a visual analogue pain scale. Adverse effects and amount of acetaminophen consumed by each individual were recorded by the research staff.
RESULTS:
In comparing the two groups, results show a similar decrease in mean pain score in the ED and at scheduled follow-up. However, of the 46 patients in the indomethacin group, 29 patients experienced adverse events, 7 requiring hospital admission and 5 suffered GI bleeds, which were confirmed by upper endoscopy. Twelve, of the 44 patients experienced adverse events in the prednisolone group, none requiring hospital admission. The mean total dose of acetaminophen consumed in the indomethacin and prednisolone groups over a 14 day period were 6.4 g range (1 to 21g) and 10.3 g range (1 to 21g), respectively.
COMMENTS:
Results in this study show patients experience similar pain relief with prednisolone and indomethacin, for the treatment of acute goutlike arthritis. Prednisolone, when compared to indomethacin, appears to be safer with less adverse events.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.