Comparison of adrenocorticotropic hormone and triamcinolone acetonide in the treatment of acute gouty arthritis.
OBJECTIVE
To determine the best alternative therapy for acute gouty arthritis when nonsteroidal antiinflammatory drugs or colchicine are contraindicated.


METHODS
Thirty-one patients with crystal proven gout presenting with an acute attack of < 5 days' duration were treated prospectively with either a single intramuscular injection of adrenocorticotropic hormone (ACTH) 40 IU or triamcinolone acetonide 60 mg. The patients were followed for 30 days.


RESULTS
Resolution of all symptoms occurred at an average of 8 days for both groups. No adverse reactions were noted in either group; however, there were 11 reinjections in the ACTH group and 5 reinjections in the triamcinolone acetonide group. Two patients from the ACTH arm were transferred to the triamcinolone acetonide arm because of rebound arthritis.


CONCLUSIONS
Although recent studies of ACTH and triamcinolone acetonide have demonstrated efficacy and safety comparable to indomethacin, in a direct comparison of the 2 at the doses used, triamcinolone acetonide resulted in fewer rebound attacks and treatment failures than ACTH and required fewer reinjections.
N. Chicago VAMC, Medical Service, IL 60064.
L B
LB
Siegel
J A
JA
Alloway
D J
DJ
Nashel
D000208:Acute Disease; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D015210:Arthritis, Gouty / Q000188:drug therapy*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*
D000324:Adrenocorticotropic Hormone; D014222:Triamcinolone Acetonide