Intra-articular glucocorticoids for acute gout

This summary of a Cochrane review presents what we know from research about the effect of glucocorticoid injections (into affected joints) in people with acute gout. There were no trials that met our inclusion criteria, and no trials measuring the effect on pain, inflammation, the number of withdrawals due to adverse events, function, quality of life, treatment success and serious adverse events. Studies of glucocorticoid injections in other conditions that lead to joint pain suggest that this therapy may be well tolerated, relatively safe and effective in relieving pain.

What is gout, and what are intra-articular glucocorticoids?

Gout is a disease caused by high uric acid levels in the blood leading to crystal formation in the joints. People with gout can have flares of extremely painful, warm, red and swollen joints, usually in the big toe, ankle or knee. Gout usually presents as acute attacks causing joint swelling and pain but also can lead to chronic arthritis. While there is no cure for the disease, treatment can prevent recurrent gout attacks and improve its chronic form. Acute attacks may be provoked by trauma, ingesting certain medications (for example diuretics), hospitalisation, alcohol use and surgery.

Intra-articular glucocorticoids are a medication that is injected into joints; glucocorticoids are man-made drugs that closely resemble cortisol, a hormone that is produced by the adrenal glands. Oral pain or anti-inflammatory medications are usually used to treat acute gout. Intra-articular glucocorticoids are used if the usual medications don't work or if people are unable to take the usual medications because of other health problems.

While we were unable to find any controlled trials that have compared intra-articular glucocorticoids to placebo or another treatment, trials of intra-articular glucocorticoids for other conditions including osteoarthritis (some of which include people who have other types of crystals in their joints) and rheumatoid arthritis have found that this treatment is effective and safe. It is likely that these results would be generalisable to people with acute gout.

Authors' conclusions: 

There is presently no evidence from randomised trials to support the use of intra-articular glucocorticoid treatment in acute gout. Evidence suggests intra-articular glucocorticoids may be a safe and effective treatment in osteoarthritis and rheumatoid arthritis. These results may be generalisable to people with acute gout, and the treatment may be especially useful in people when non-steroidal anti-inflammatory drugs or colchicine are contraindicated.

Read the full abstract...
Background: 

Although intra-articular glucocorticoids are a commonly used intervention in the treatment of acute gout, there is little evidence to support their safety and efficacy in this setting.

Objectives: 

To evaluate the safety and efficacy of intra-articular glucocorticoids in the treatment of acute gout.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE and Ovid EMBASE for studies to 16th October 2012. We also searched the 2010 to 2011 American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) abstracts and performed a handsearch of the reference lists of articles considered for inclusion.

Selection criteria: 

Studies were eligible for inclusion if they were randomised controlled trials (RCTs) or controlled clinical trials (CCTs) that used quasi-randomisation methods to allocate participants to treatment and compared intra-articular glucocorticoids to another therapy (active or placebo) in adults with acute gout. Outcomes selected for inclusion were pain, the proportion of participant withdrawals due to adverse events, inflammation, function, patient global assessment of treatment success, quality of life and proportion of particpants with serious adverse events.

Data collection and analysis: 

Two review authors independently selected the studies for inclusion and planned to extract the data and perform a risk of bias assessment.

Main results: 

No trials were identified that evaluated the efficacy and safety of intra-articular glucocorticoids for acute gout.

Share/Save
Health topics: