Oral Prednisolone in the Treatment of Acute Gout A Pragmatic, Multicenter, Double-Blind, Randomized Trial
Oral Prednisolone in the Treatment of Acute Gout A Pragmatic, Multicenter, Double-Blind, Randomized Trial
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DOI：
10.7326/m14-2070
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发表时间：
2016-04-05
影响因子：
39.2
通讯作者：
Graham, Colin Alexander
中科院分区：
文献类型：
--
作者：
Rainer, Timothy Hudson;Cheng, Chi Hung;Graham, Colin Alexander
Background: Two recent double-blind, randomized, controlled trials (RCTs) showed that oral steroids and nonsteroidal antiinflammatory 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 (1: 1 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.
