Treatment of acute gout: a systematic review.

Autor: Khanna PP; Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422. Electronic address: pkhanna@umich.edu., Gladue HS; Emory University, Atlanta, GA., Singh MK; Rochester General Health System, Rochester, NY., FitzGerald JD; David Geffen School of Medicine, UCLA, Los Angeles, CA., Bae S; David Geffen School of Medicine, UCLA, Los Angeles, CA., Prakash S; David Geffen School of Medicine, UCLA, Los Angeles, CA., Kaldas M; David Geffen School of Medicine, UCLA, Los Angeles, CA., Gogia M; David Geffen School of Medicine, UCLA, Los Angeles, CA., Berrocal V; Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422., Townsend W; Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422; Taubman Health Science Library, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422., Terkeltaub R; VAMC/UCSD, La Jolla, CA., Khanna D; Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2014 Aug; Vol. 44 (1), pp. 31-8. Date of Electronic Publication: 2014 Feb 13.
DOI: 10.1016/j.semarthrit.2014.02.003
Abstrakt: Objective: Acute gout is traditionally treated with NSAIDs, corticosteroids, and colchicine; however, subjects have multiple comorbidities that limit the use of some conventional therapies. We systematically reviewed the published data on the pharmacologic and non-pharmacologic agents used for the treatment of acute gouty arthritis.
Methods: A systematic search was performed using PubMed and Cochrane database through May 2013. We included only randomized controlled trials (RCTs) that included NSAIDs, corticosteroids, colchicine, adrenocorticotropic hormone (ACTH), interleukin-1 (IL-1) inhibitors, topical ice, or herbal supplements.
Results: Thirty articles were selected for systematic review. The results show that NSAIDs and COX-2 inhibitors are effective agents for the treatment of acute gout attacks. Systemic corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use. ACTH is suggested to be efficacious in acute gout. Oral colchicine demonstrated to be effective, with low-dose colchicine demonstrating a comparable tolerability profile as placebo and a significantly lower side effect profile to high-dose colchicine. The IL-1β inhibitory antibody, canakinumab, was effective for the treatment of acute attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine. However, rilonacept was demonstrated to be not as effective, and there are no RCTs for the use of anakinra.
Conclusion: NSAIDs, COX-2 selective inhibitors, corticosteroids, colchicine, ACTH, and canakinumab have evidence to suggest efficacy in treatment of acute gout.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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