Study Summaries: Oral Steroids: A Safe And Effective Alternative
Janssens et al conducted a double-blind, randomized equivalence trial of 118 patients to compare the efficacy of prednisolone and naproxen for the treatment of monoarticular gout, confirmed by crystal analysis of synovial fluid. The study was conducted in the eastern Netherlands at a trial center patients were referred to by their family physicians. Those with major comorbidities, including a history of GI bleed or peptic ulcer, were excluded.
Participants were randomized to receive either prednisolone 35 mg* or naproxen 500 mg twice a day, with look-alike placebo tablets of the alternate drug, for 5 days. Pain, the primary outcome, was scored on a validated visual analog scale from 0 mm to 100 mm . The reduction in the pain score at 90 hours was similar in both groups. Only a few minor side effects were reported in both groups, and all completely resolved in 3 weeks.
Who Gets Gout Gout Risk Factors
Gout happens when too much uric acid builds up in the body. Uric acid is a normal waste product in the blood resulting from the breakdown of certain foods. Uric acid usually passes through the kidneys and is eliminated from the body in urine. But it can build up in the blood and form painful, spiky crystals in your joints. This may happen if the body is making too much uric acid or if the kidneys are having a hard time filtering it out.
Having too much uric acid in the blood is a condition called hyperuricemia. Certain foods, medicines, and lifestyle factors can cause high uric acid levels in the blood, triggering a gout attack.
Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. Purines are found in certain high-protein foods and some drinks. It used to be thought that gout was caused only by lifestyle and diet, but new research has found that’s not true instead, gout is thought to have a genetic link. Diet, however, does play a role in the disease.
Other risk factors for gout include:
- Being a man
- Type 2 diabetes
- Health conditions that cause rapid turnover of cells
- KelleySeegmiller syndrome or LeschNyhan syndrome
How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
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Steroid May Be Safe Effective Gout Treatment
Doctor says this appears to offer options for pain management
Researchers who compared the steroid prednisolone with the arthritis medication indomethacin found both drugs offered a similar degree of pain reduction. And while indomethacin appeared to cause more minor side effects, neither treatment prompted serious complications, the researchers said.
Smaller investigations have pointed in the same direction, said study lead author Dr. Timothy Rainer, a professor of emergency medicine at Cardiff University in Wales. But because the new findings are the product of a “larger and better-designed” effort, Rainer said steroid pills may gain standing among gout experts who usually stick with NSAIDs as their first-line treatment.
The bottom line is that there are choices, said Dr. Philip Mease, a rheumatologist with the Swedish Medical Center in Seattle.
“That is the key message — that there are options,” said Mease, who wasn’t involved in the study. “Sometimes ER docs don’t think about giving a tapering dose of prednisone, but it can be very effective at helping with gout, which can be damn painful.”
Gout is the most common form of inflammatory arthritis among men, the study team said, affecting about 3 percent of adults in the United States.
Intense Big Toe Pain From Gout: A Classic Symptom Of An Attack
While the big toe is the most common place for a gout attack to happen, gout can also affect surrounding joints in the foot, ankle, and knee.
People with gout typically experience flare-ups, or attacks, of symptoms followed by periods with no symptoms. The attacks typically last 3 to 10 days. Some people go months or even years without a gout attack after having one. In other people, attacks may become more frequent over time.
Gout can be difficult to diagnose. Once its diagnosed, it can be treated with medication and lifestyle changes.
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Acute Gout: Oral Steroids Work As Well As Nsaids
J Fam Pract
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
Bernard Ewigman, MD, MSPHDepartment of Family Medicine, The University of Chicago
PURLs EDITORDepartment of Family Medicine, The University of Chicago
Prednisone is a safe and effective alternative when NSAIDs are contraindicated.
Which Corticosteroid Regimens Are Recommended For Acute Gout
Prednisone can be given at a dose of approximately 40 mg for 1-3 days, which is then tapered over approximately 2 weeks . Monitor closely for corticosteroid effects. If treatment continues for more than 2 weeks, consider measures to prevent osteoporosis.
Intra-articular long-acting corticosteroids are particularly useful in patients with a monoarticular flare to help reduce the systemic effects of oral steroids. Ensuring that the joint is not infected before injecting intra-articular corticosteroids is particularly important.
An alternative to corticosteroid administration is to give ACTH to induce production of corticosteroid by the patients own adrenal glands. Such a regimen does not depend on the patient for proper tapering of prednisone.
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Data Sources And Search
We performed a comprehensive search of MEDLINE via PubMed for full-text English-language articles that were published from 1963 to 2013. The following search terms were used to retrieve key papers: gout, flares, arthritis, prophylaxis, prevention, uric acidlowering therapy, urate-lowering therapy, allopurinol, febuxostat, pegloticase, benzbromarone, probenecid, colchicine, NSAIDs, corticosteroids, canakinumab, anakinra, rilonacept and IL-1 blockers.
Carrying A Steroid Card
If you’re taking high doses of steroids, or if you’re on them for more than three weeks, you’ll need to carry a steroid card. This will have information on your dose and how long you’ve been taking them for.
Your doctor, rheumatology nurse or pharmacist should give you a steroid card if you need one. Make sure any change to your dose of steroid is updated on the card.
Steroid treatment can stop the body producing natural hormones, which can be dangerous if you get ill, have an accident or need an operation. Keeping the card with you will help any other doctor who treats you to manage your care correctly.
If you have any questions or concerns about this, talk to the healthcare professional who prescribed your steroids.
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Other Symptoms Of Acute Gout Or A Gout Attack
- Sudden crushing or throbbing pain in one or a few joints that may last for a few days
- Sometimes an acute gouty arthritis attack has a sudden onset at nighttime. The big toe joint pain may be so severe that even the weight of bedsheets causes discomfort.
- Joints that appear swollen and inflamed, with reddish-purple skin that may feel warm
What Are The Side Effects Of Prednisone
Steroids come with a long list of side effects. Theyâre more common with oral medications like prednisone because it affects your entire body. Youâre also more likely to get them if youâre taking a high dose over a long time. Some side effects are more serious and longer-lasting than others.
Common side effects of prednisone include:
- Water retention, swelling in lower legs
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Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
What Does Prednisone Do
Prednisone, like other corticosteroids, quickly lowers inflammation, which cuts down on pain, redness, and swelling. It also dials down your immune system. Under normal conditions, this system protects you against things like viruses and bacteria that cause infections and diseases.
Sometimes your immune system overreacts and attacks your body’s tissues. Prednisone stops that attack. Thereâs also proof that low-dose prednisone may slow joint damage in people with rheumatoid arthritis, but not as much as other arthritis medications do. It can also cause unpleasant long-term side effects.
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Chronic Gout Signs And Symptoms
- Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.
- Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
- Hard white deposits or lumps under the skin, called tophi, found on the elbows, ears, or fingers.
Result Of The Literature Search On Prophylactic Drugs
We retrieved 44 articles for review, of which 17 did not specifically investigate gout. Thirteen of the 27 remaining articles did not have a randomized controlled design, were a post hoc analysis or were published in a non-English language, and were thus excluded. We excluded four additional articles that investigated either the treatment of acute GFs or their prophylaxis in the absence of ULT. Finally, five studies met our eligibility criteria. The main results of these RCTs are summarized in .
Design and main results of published reports of randomized controlled trials assessing prophylaxis for acute gout flares
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When Asked How Long Does Gout Last Most People Would Say A Few Days To A Few Weeks
How long does gout last? Your symptoms, treatment, and diet all come into play.
A gout attack can cause sudden and very severe joint pain. It frequently starts in the joint of a big toe and may wake you up at night. Even having a sheet resting on your toe can be painful. A gout attack can make you miserable. It may last from three days to up to two weeks. Taking medication usually helps reduce the pain and may shorten the attack. But even without medication, a gout attack usually goes away within ten days.
Once you have had an attack of gout, you need to start treatment to prevent another attack, because gout often comes back. Without treatment, you can expect another attack within two years. People with frequent attacks can develop a type of long-term gout that does not go away. It can cause painful lumps in or near joints and can cause damaging deformity of a joint. The good news is that treatment works well. Gout is very controllable for most people.
What To Do For A Gout Attack
Medication may shorten a gout attack. Your doctor may prescribe medication that blocks inflammation called a nonsteroidal anti-inflammatory drug , you may also take a drug called colchicine or a strong anti-inflammatory steroid drug. Over-the-counter NSAIDs include ibuprofen and naproxen.
These drugs will reduce the pain and inflammation, but there are also home treatments that will help. Home treatment includes resting your joint, elevating your joint above the level of your heart, and using ice packs to reduce pain and swelling.
Read Also: Printable List Of Foods To Avoid With Gout
How Do We Prevent Gout Flare
Generally, we need to get your uric acid levels lower to prevent gout flare-ups. Firstly, you need to treat lifestyle factors. Examples include losing weight, reducing alcohol intake, and a healthy diet. Secondly, your doctor may prescribe medications to lower uric acid. The most common drug is allopurinol. It is important to wait until an acute attack has settled before starting this drug. Speak to your doctor about whether you should consider this drug. In general, preventative medication such as Alluprinol is useful if youre uric acid levels are high .
When you start taking Allopurinol, you should take another tablet such as colchicine for about 4 weeks to prevent another attack.
Typically, a change in lifestyle can reduce uric acid levels. Examples of foods that increase purine and should be avoided include organ meats, sardines, anchovies, prawns, board beans, and foods containing a high concentration of high fructose corn sugar. In addition, yeast and yeast-based foods such as frozen foods and canned food can be problematic. Also, sugar-sweetened beverages and alcoholic drinks increase acid levels. Generally, wine is better than hard liquor or beer.
On the contrary, foods that reduce uric acid include cherries, fruit and vegetables high in vitamin C, low-fat dairy products, and a vegetarian diet. Also, keeping well hydrated can prevent and treat an attack.
Who Should Not Take This Medication
Do not take this medication if you:
- are allergic to prednisone or any ingredients of this medication
- have an internal fungal infection
- will be given a live virus vaccine and are taking large immunosuppressive doses of prednisone
- have herpes simplex of the eye, except for short-term or emergency treatment of allergic-type reactions
- have measles or chickenpox, except for short-term or emergency treatment of allergic-type reactions
- have peptic ulcers
- have diverticulitis
- have undiagnosed inflammation of the digestive system
- have a viral or bacterial infection that is not controlled by medications
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Now Its Your Turn To Understand How Long To Take Prednisone For Gout Attack
Theres nowadays thousands of us who no longer go through gout because we tackled it at its trigger. Rather than just tinkering with the outward symptoms.
Im one of them!
Remember, I got gout for exactly the same reasons you own it today.
An unhealthy gut microbiome supposed that bacteria that should have been taking away one third of my bodys uric acid simply wasnt.
That bacteria experienced diminished to the stage that my kidneys had been trying to cope with the acid on their own.
And they couldnt cope.
Nor can yours.
It wasnt that we was suddenly generating an excessive amount of uric acid. It agains that my gut was initially no in a position to help my kidneys remove it from my own body longer.
And the transformation from gout to no gout felt like magic almost.
You can possibly imagine it yourself.. what it would be like to simply never have any gout ever again.
Take my word for it, its wonderful!
No flare-ups, no pain, no being laid-up in bed for days waiting for the pain to subside.
No asking yourself if some upcoming occasion will be smudged because Im laid up in agony with another episode.
In the same way pleasing is the fact that Ive likewise drastically reduced my dangers of struggling diabetes, kidney failure, cardiovascular disease and some cancers.
Shellys program lays it all out for us. No special knowledge is required. I found it easy.
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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