Rheumatology

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Cochrane Musculoskeletal Group review: Acute gout
The Journal of Family Practice, 07/02/09

Winzenberg T et al. - Gout afflicts about 2% of men over age 30 and women over age 50 and its prevalence appears to be increasing. Options for treating acute gout include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and intra-articular and systemic corticosteroids. Choosing among them can be challenging, however, because the evidence that one or another of these options yields real benefit is of varying strength. Using NSAIDs can be problematic with increasing age, as comorbidities like gastrointestinal (GI) bleeding, renal failure, heart failure, and cardiovascular risk increase and anticoagulant therapy is more likely to be in use. That’s where the kind of systematic reviews Cochrane Musculoskeletal Group (CMSG) performs can be of real help.

• Test your skills with 2 cases
• All 22 participants who took colchicine developed diarrhea or vomiting within 24 hours of initiating therapy
• One RCT found that oral prednisolone 35 mg daily and naproxen 500 mg twice daily were clinically equivalent
• NSAIDs are a reasonable first option, provided there are no contraindications

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