From the Guidelines
Corticosteroids should be considered as first-line therapy for acute gout in the left knee, due to their effectiveness in reducing pain and inflammation, as well as their relatively low cost and safety profile compared to other treatment options. According to the American College of Physicians guideline 1, high-quality evidence supports the use of corticosteroids, NSAIDs, and colchicine for reducing pain in patients with acute gout. Some key points to consider when using corticosteroids for gout include:
- Prednisolone at a dose of 35 mg for 5 days has been shown to be effective in treating acute gout 1
- Corticosteroids are generally safer and have fewer adverse effects compared to NSAIDs, making them a good option for patients without contraindications 1
- Adverse effects associated with long-term use of corticosteroids include dysphoria, mood disorders, elevation of blood glucose levels, immune suppression, and fluid retention 1
- Corticosteroids are contraindicated in patients with systemic fungal infections or known contraindications 1 In addition to corticosteroids, other treatment options for gout include NSAIDs and colchicine, which can be used in patients who are unable to take corticosteroids or have contraindications to their use. It's also important to note that while corticosteroids can provide quick relief from gout symptoms, they do not address the underlying cause of gout, which is high uric acid levels. For long-term management, medications that lower uric acid levels, such as allopurinol or febuxostat, may be necessary, along with dietary modifications to reduce purine intake.
From the FDA Drug Label
Rheumatic disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; Intra-Articular The intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis,
Steroids, such as triamcinolone acetonide, can be used to treat acute gouty arthritis, including in the left knee. The intra-articular administration of this medication is indicated for short-term use to manage acute episodes or exacerbations of gout 2.
From the Research
Treatment Options for Gout in the Left Knee
- Steroids, such as prednisolone, can be used to treat acute gout in the left knee, with studies showing comparable efficacy to non-steroidal anti-inflammatory drugs (NSAIDs) 3
- Intra-articular glucocorticoids, such as triamcinolone acetonide, can also be effective in treating acute gout, with moderate-quality evidence indicating that canakinumab 150 mg is probably superior to triamcinolone acetonide 40 mg in terms of pain relief and joint swelling 4
- Systemic corticosteroids, such as oral prednisolone, have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use 5, 6
Efficacy and Safety of Steroids for Gout Treatment
- Oral prednisolone (30-35 mg/day) was found to be comparable with NSAIDs (naproxen at 500 mg/day or indomethacin at 50-100 mg/day) on the pain relief scale, both in activity and at rest 3
- Prednisolone did not increase the total adverse events (AEs) and reduced the withdrawal rate because of the AEs, but increased the risk of skin rashes 3
- Canakinumab 150 mg was found to be probably superior to triamcinolone acetonide 40 mg in terms of pain relief, joint swelling, and participant-assessed global assessment of treatment response, but was probably associated with an increased risk of adverse events 4
Comparison with Other Treatment Options
- NSAIDs, COX-2 inhibitors, corticosteroids, colchicine, adrenocorticotropic hormone (ACTH), and canakinumab have evidence to suggest efficacy in the treatment of acute gout 5
- Low-dose colchicine was found to be safer than high-dose colchicine, with a comparable tolerability profile to placebo 5, 6
- ACTH is suggested to be efficacious in acute gout, with exciting new research showing that corticotropin acts peripherally by activation of the melanocortin type 3 receptor 7