A short course of a corticosteroid could supplant nonsteroidal anti-inflammatory drugs (NSAIDs) as the medication of choice for the treatment of gout, a Dutch team suggests. Prednisolone proved as effective as naproxen in their clinical trial, while averting the GI, renal, and cardiovascular complications that NSAIDs can entail.

About 40% of upper GI bleeding events are attributable to NSAIDs, the researchers note, with the highest risk apparent during the first week of use. “The drawbacks of NSAIDs are especially important in cases of gout because patients are at high risk for the GI side effects,” the researchers write. “Most of them are middle-aged or elderly, and many have comorbid renal and cardiovascular diseases.”

Hein J.E.M. Janssens, MD, of Radboud University Nijmegen Medical Center in the Netherlands led the team, which treated 120 gout patients in primary care. Half were randomly assigned to receive prednisolone 35 mg once a day. The other half were given naproxen 500 mg twice a day.

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Using a visual analog scale that ranged from 0 to 100 mm, the researchers assessed the patients’ pain. After 90 hours, the pain scores fell 44.7 mm in the prednisolone group and 46.0 mm in the naproxen group, “suggesting equivalence” over the four days of treatment. Adverse effects were similar and minor, resolving within three weeks (Lancet. 2008;371:1854-1860).  

Long-term use of corticosteroids is associated with osteoporosis, fluid retention, and hyperglycemia, but these side effects are not an issue in a short course of treatment, the researchers point out.

“The present study provides a strong argument to consider prednisolone as a first treatment option,” they conclude.