Intervention Review

Systemic corticosteroids for acute gout

  1. Hein J Janssens1,*,
  2. Peter LBJ Lucassen2,
  3. Floris A Van de Laar3,
  4. Matthijs Janssen4,
  5. Eloy H Van de Lisdonk5

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 23 APR 2008

Assessed as up-to-date: 7 DEC 2007

DOI: 10.1002/14651858.CD005521.pub2


How to Cite

Janssens HJ, Lucassen PLBJ, Van de Laar FA, Janssen M, Van de Lisdonk EH. Systemic corticosteroids for acute gout. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005521. DOI: 10.1002/14651858.CD005521.pub2.

Author Information

  1. 1

    Lobith, Netherlands

  2. 2

    Radboud University Medical Centre, Department of General Practice and Family Medicine, Nijmegen, Netherlands

  3. 3

    Radboud University Nijmegen Medical Centre, Department of General Practice, 117 HAG, Nijmegen, Netherlands

  4. 4

    Rijnstate Hospital Arnhem, Rheumatology, Arnhem, Netherlands

  5. 5

    Radboud University Medical Centre Nijmegen, Department of General Practice and Family Medicine, 117 HAG, Nijmegen, Netherlands

*Hein J Janssens, Transeedijk 62, Lobith, 6915 XZ, Netherlands. h.janssens2@chello.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Gout is one of the most frequently occurring rheumatic diseases, worldwide. Given the well-known drawbacks of the regular treatments for acute gout (non-steroidal anti-inflammatory drugs (NSAIDs), colchicine), systemic corticosteroids might be safe alternatives.

Objectives

To assess the efficacy and safety of systemic corticosteroids in the treatment of acute gout in comparison with placebo, NSAIDs, colchicine, other active drugs, other therapies, or no therapy.

Search methods

Searches were done in the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007); MEDLINE (1966 to 2007) through PubMed; EMBASE (1974 to 2007); Web of Science (1975 to 2007); LILACS (1986 to 2007); and databases of ongoing trials (up to April 2007).

Selection criteria

Randomized controlled trials and controlled clinical trials investigating the use of systemic corticosteroids in the treatment of acute gout were included.

Data collection and analysis

Two review authors decided independently which trials to include. The same review authors also collected the data in a standardised form and assessed the methodological quality of the trial using validated criteria. When possible, continuous and dichotomous data were summarised statistically.

Main results

Three head to head trials involving 148 patients (74 systemic corticosteroids; 74 comparator drugs) were included. Placebo-controlled trials were not found. In the studies, different kinds of systemic corticosteroids and different kinds of control drugs were used, both administered in different routes. Intramuscular triamcinolone acetonide was compared respectively to oral indomethacine, and intramuscular adrenocorticotropic hormone (ACTH); oral prednisolone (together with a single intramuscular diclophenac injection) was compared to oral indomethacine (together with a single placebo injection). Outcome measurements varied: average number of days until total relief of signs, mean decrease of pain per unit of time in mm on a visual analogue scale (VAS) - during rest and activity. In the triamcinolone-indomethacine trial the clinical joint status was used as an additional outcome. Clinically relevant differences between the studied systemic corticosteroids and the comparator drugs were not found; important safety problems attributable to the used corticosteroids were not reported. The quality of the three studies was graded as very low to moderate. Statistical pooling of results was not possible.

Authors' conclusions

There is inconclusive evidence for the efficacy and effectiveness of systemic corticosteroids in the treatment of acute gout. Patients with gout did not report serious adverse effects from systemic corticosteroids, when used short term.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Systemic corticosteroids for acute gout

This summary of a Cochrane review presents what we know from research about the effect of systemic corticosteroids for acute gout. The review shows that in people with gout:

- systemic corticosteroids may slightly improve patients' assessment of pain and disability. However, this could have occurred by chance;
- there is no precise information about side effects and complications. Only a minority of the patients treated with the steroid oral prednisolone reported minor side effects.

What is gout, and what are systemic corticosteroids?

Gout is a sudden, very painful joint inflammation (arthritis). It usually affects the big toe. The inflammation, which is caused by urate crystals, leads to swelling and redness of the joint, and makes it painful to move or even to touch.
Systemic corticosteroids are drugs that imitate the corticosteroids that are naturally produced by your own body and may help reduce swelling, redness and pain in joints. Systemic corticosteroids come in a pill form or as an injection given by your doctor.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

全身性類固醇治療急性痛風關節炎

痛風是常見慢性類風濕性關節疾病。針對急性痛風關節炎治療藥物如非類固醇消炎止痛藥及秋水仙的副作用,全身性類固醇治療可能是安全的選擇。

目標

研究全身性類固醇與安慰劑、非類固醇消炎止痛藥、秋水仙素、其它止痛藥、其他治療或不治療,其治療急性痛風關節炎之效果及安全性比較。

搜尋策略

搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007); 由PubMed 搜尋MEDLINE (1966 to 2007) EMBASE (1974 to 2007) eb of Science (1975 to 2007); LILACS (1986 to 2007); and databases of ongoing trials (到2007年4月)。

選擇標準

選入以全身性類固醇注射治療急性痛風關節炎之隨機對照試驗及控制對照試驗的研究。

資料收集與分析

兩位作者獨立選擇何項試驗被納入並進行資料摘錄,並對每篇試驗研究的品質已經過效度評估之工具進行評估。如可能,連續性資料及二分法類別資料以統計分析總結。

主要結論

包括了3個直接比較研究包含148例病患,其中74位為全身性類固醇注射,74位為比較藥物。這三項研究中並未發現安慰劑對照控制試驗。其研究包含不同類固醇、不同非類固醇消炎止痛藥、不同施用途徑。其中肌肉注射triamcinolone acetonide與口服indomethacine、肌肉注射adrenocorticotropic hormone (ACTH)比較;口服prednisolone (同時單一肌肉注射一次diclophenac) 與口服indomethacine (同時肌肉注射一次安慰劑)。這三項研究結果測量指標不同:包括了到表徵完全緩解天數、在休息及活動時單位時間內以視覺類比量表VAS (visual analogue scale) 測量單位時間內(分鐘)平均減少的疼痛。在肌肉注射triamcinolone acetonide研究,臨床關節狀況也是測量指標。並未發現肌肉注射類固醇與其他比較藥物治療,有臨床有意義差別,用類固醇的重要安全問題並未被報告。這三項研究的品質認為是低到中等。且無法結合作統合分析。

作者結論

全身性類固醇治療急性痛風關節炎之效果及安全性無法下結論。病患短期使用全身性類固醇治療急性痛風關節炎未被報告有嚴重之副作用產生。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

全身性類固醇治療急性痛風。 此Cochrane回顧摘要了我們所知道的有關全身性類固醇治療急性痛風效果的研究。這項回顧表明,在痛風病患:全身性類固醇可能會略有改善病人的疼痛和不便殘疾。不過,這可能是偶然發生的,沒有確切有關副作用和併發症的資訊。只有少數患者口服類固醇治療有報告輕微副作用。 什麼是痛風,以及全身性類固醇是什麼? 痛風是一種突然的,非常疼痛的關節發炎(關節炎)。它通常會影響大腳趾。因尿酸結晶造成的發炎,導致腫脹和發紅的關節,並使移動,甚至觸摸都會疼痛。全身性類固醇是皮質類固醇藥物,模仿的是自己的身體天然產生的皮質類固醇,並且可能有助於減輕腫脹,發紅及關節疼痛。全身性類固醇可藉由藥丸或醫生注射給予。