Systemic corticosteroids versus non-steroidal anti-inflammatory drugs for acute gout
Abstract
OBJECTIVE
to compare pain reduction and adverse events between systemic corticosteroids and NSAIDs in patients with acute gout.
METHODS
Four reviewers systematically and independently searched and evaluated from 4 databases including PubMed, the Cochrane Library, Trip database and Scopus. We included all relevant randomized controlled trials (RCTs) comparing efficacy regarding pain reduction and adverse events of systemic corticosteroids and NSAIDs in patients with acute gout by robust inclusion and exclusion criteria. We assessed the methodological quality using validated tools. Then, continuous and dichotomous data were statistically analysed.
RESULTS
We include 5 RCTs, involving 834 participants with acute gout in this systematic review. Three RCTs with 624 patients indicated that systemic corticosteroids and NSAIDs were similar efficacy in term of pain reduction at rest using a 100 mm-visual analogue scale (VAS) in the first 6 hours (mean difference [MD] 0.64; 95% confidence interval [CI] -2.26 to 3.54, I2=50%, random-effect model). Two RCTs with 506 participants, systemic corticosteroids were not significantly different from NSAIDs for efficacy in term of pain reduction at activity using a 100 mm-VAS in the first 6 hours (MD -0.28; 95% CI -2.09 to 1.53, I2=0%, fixed-effect model). Three minor adverse events including nausea, vomiting and indigestion were found significantly higher in those using NSAIDs, (relative risk [RR] 0.23; 95% CI 0.11 to 0.51; RR 0.1; 95% CI 0.02 to 0.54 and RR 0.49; 95% CI 0.28 to 0.84, respectively) while rash was more common in those using systemic corticosteroids (RR 4.61; 95% CI 1.34 to 15.81).
CONCLUSION
Our study found robust evidence that systemic corticosteroids and NSAIDs have similar efficacy for pain reduction but have lesser adverse events in systemic corticosteroids users. Thus, short-term systemic corticosteroids treatment should be considered as first-line alternative to NSAIDs in patients with acute gout.
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