Effectiveness of interventions for the treatment of acute and prevention of recurrent gout--a systematic review.
OBJECTIVE
To determine the evidence for the effectiveness of treatments for acute gout and the prevention of recurrent gout.


METHODS
Seven electronic databases were searched for randomized controlled trials of treatments for gout from their inception to the end of 2004. No language restrictions were applied. All randomized controlled trials of treatments routinely available for the treatment of gout were included. Trials of the prevention of recurrence were included only if patients who had had gout and had at least 6 months of follow-up were studied.


RESULTS
We found 13 randomized controlled trials of treatment for acute gout, two of which were placebo controlled. Colchicine was found to be effective in one study; however, the entire colchicine group developed toxicity. The only robust conclusion from studies of non-steroidal anti-inflammatory drugs is that pain relief from indometacin and etoricoxib are equivalent. We found one randomized controlled trial, reported only as a conference abstract, of recurrent gout prevention.


CONCLUSIONS
The shortage of robust data to inform the management of a common problem such as gout is surprising. All of the drugs used to treat gout can have serious side effects. The incidence of gout is highest in the elderly population. It is in this group, who are at a high risk of serious adverse events, that we are using drugs of known toxicity. The balance of risks and benefits for the drug treatment of gout needs to be reassessed.
Sutaria
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S
Barts and The London, Queen Mary, University of London, Institute of Health Sciences, London, UK. shailen000@yahoo.co.uk
Katbamna
R
R
Underwood
M
M
D000208:Acute Disease; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D006073:Gout / Q000188:drug therapy* / Q000517:prevention & control; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D003078:Colchicine