No Evidence Backs Intra-articular Glucocorticoids for Acute Gout

May 16, 2013

They may be supported by guidelines and commonly used in practice, but joint injections with glucocorticoids for acute gout are not backed by any randomized controlled clinical trials, according to a new Cochrane report. However, the report backs away from saying they should not be used.

Wechalekar MD, Vinik O, Schlesinger N, et al.Intra-articular glucocorticoids for acute gout.” Cochrane Database Syst Rev. 2013;4:CD009920

Intra-articular glucocorticoids may be a common treatment for people who can’t tolerate other therapies for acute gout, and one supported by guidelines, but a new report in the Cochrane Database of Systematic Reviews says there is little actual evidence for their safety and efficacy in this setting.

Screening 150 trials, the review finds only two relevant studies, and no randomized, clinical trial (RCT) or controlled clinical trial (CCT) data, to support the value of injected glucocorticoids in reducing inflammation or pain or improving quality of life for patients with acute gout.

The joint injections -- including shorter-acting soluble (e.g., phosphate salts, betamethasone phosphate) or longer-acting insoluble salts (e.g, methylprednisolone acetate and triamcinolone hexacetonide) -- are used as stand-alone, single-dose pain relief therapy in gout when the usual medications, NSAIDs or colchicine, don’t work or are contraindicated because of other health problems such as kidney failure.

The review does find “extrapolated evidence,” in that intra-articular glucocorticoids “may be” a safe and effective treatment for osteoarthritis and rheumatoid arthritis. In light of the effectiveness of systemic glucocorticoids for acute gout, it adds, these injections “may be a useful alternative” for patients with acute gout in whom other treatments are contraindicated.