Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial.
Ann Intern Med
; 164(7): 464-71, 2016 Apr 05.
Article
en En
| MEDLINE
| ID: mdl-26903390
ABSTRACT
BACKGROUND:
Two recent double-blind, randomized, controlled trials (RCTs) showed that oral steroids and nonsteroidal anti-inflammatory drugs have similar analgesic effectiveness for management of gout, but the trials had small sample sizes and other methodological limitations.OBJECTIVE:
To compare the effectiveness and safety of oral prednisolone versus oral indomethacin in patients presenting to emergency departments (EDs) with acute gout.DESIGN:
Multicenter, double-blind, randomized equivalence trial. Patients were randomly assigned (11 ratio) to receive either indomethacin or prednisolone. (ISRCTN registry number ISRCTN45724113).SETTING:
Four EDs in Hong Kong.PARTICIPANTS:
416 patients aged 18 years or older. MEASUREMENTS Analgesic effectiveness was defined as changes in pain (at rest or with activity) greater than 13 mm on a 100-mm visual analogue scale. Outcomes were measured during the first 2 hours in the ED and from days 1 to 14.RESULTS:
376 patients completed the study. Equivalent and clinically significant within-group reductions in mean pain score were observed with indomethacin and prednisolone in the ED (approximately 10 mm [rest] and 20 mm [activity]) and from days 1 to 14 (approximately 25 mm [rest] and 45 mm [activity]). No major adverse events occurred during the study. During the ED phase, patients in the indomethacin group had more minor adverse events than those in the prednisolone group (19% vs. 6%; P < 0.001). During days 1 to 14, 37% of patients in each group had minor adverse events.LIMITATION:
Diagnosis of gout was usually based on clinical criteria rather than examination of joint fluid.CONCLUSION:
Oral prednisolone and indomethacin had similar analgesic effectiveness among patients with acute gout. Prednisolone is a safe, effective first-line option for treatment of acute gout. PRIMARY FUNDING SOURCE Health and Health Services Research Grant Committee of the Hong Kong Government.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Prednisolona
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Gota
/
Antiinflamatorios
Tipo de estudio:
Clinical_trials
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Etiology_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Asia
Idioma:
En
Revista:
Ann Intern Med
Año:
2016
Tipo del documento:
Article