title: Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial.
abstract: BACKGROUND
  Two recent double-blind, randomized, controlled trials (RCTs) showed that oral steroids and nonsteroidal anti-inflammatory drugs have similar analgesic effectiveness for management of gout, but the trials had small sample sizes and other methodological limitations.
  
  
  OBJECTIVE
  To compare the effectiveness and safety of oral prednisolone versus oral indomethacin in patients presenting to emergency departments (EDs) with acute gout.
  
  
  METHODS
  Multicenter, double-blind, randomized equivalence trial. Patients were randomly assigned (1:1 ratio) to receive either indomethacin or prednisolone. (ISRCTN registry number: ISRCTN45724113).
  
  
  METHODS
  Four EDs in Hong Kong.
  
  
  METHODS
  416 patients aged 18 years or older.
  
  
  METHODS
  Analgesic effectiveness was defined as changes in pain (at rest or with activity) greater than 13 mm on a 100-mm visual analogue scale. Outcomes were measured during the first 2 hours in the ED and from days 1 to 14.
  
  
  RESULTS
  376 patients completed the study. Equivalent and clinically significant within-group reductions in mean pain score were observed with indomethacin and prednisolone in the ED (approximately 10 mm [rest] and 20 mm [activity]) and from days 1 to 14 (approximately 25 mm [rest] and 45 mm [activity]). No major adverse events occurred during the study. During the ED phase, patients in the indomethacin group had more minor adverse events than those in the prednisolone group (19% vs. 6%; P < 0.001). During days 1 to 14, 37% of patients in each group had minor adverse events.
  
  
  CONCLUSIONS
  Diagnosis of gout was usually based on clinical criteria rather than examination of joint fluid.
  
  
  CONCLUSIONS
  Oral prednisolone and indomethacin had similar analgesic effectiveness among patients with acute gout. Prednisolone is a safe, effective first-line option for treatment of acute gout.
  
  
  BACKGROUND
  Health and Health Services Research Grant Committee of the Hong Kong Government.
authors.forename: Timothy Hudson
authors.initials: TH
authors.lastname: Rainer
authors.forename: Chi Hung
authors.initials: CH
authors.lastname: Cheng
authors.forename: Hein J E M
authors.initials: HJ
authors.lastname: Janssens
authors.forename: Chi Yin
authors.initials: CY
authors.lastname: Man
authors.forename: Lai Shan
authors.initials: LS
authors.lastname: Tam
authors.forename: Yu Fai
authors.initials: YF
authors.lastname: Choi
authors.forename: Wah Hon
authors.initials: WH
authors.lastname: Yau
authors.forename: Ka Hing
authors.initials: KH
authors.lastname: Lee
authors.forename: Colin Alexander
authors.initials: CA
authors.lastname: Graham
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006073:Gout / Q000188:drug therapy* / Q000503:physiopathology; D006723:Hong Kong; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D011239:Prednisolone; D007213:Indomethacin