Metabolic and Crystal Arthropathies [70-72]: 70. Single Intramuscular Depot Methylprednisolone Injection: A Convenient, Efficacious and Safe Treatment for Gouty Arthritis in an Inpatient Setting

Autor: Ishorari, Jasmine, Hassan, Nada, Dasgupta, Bhaskar, Gendi, Nagui, So, Alexander, Meulemeester, Marc D., Bodalia, Bhavesh, Shamim, Talha, Pikhlak, Andrey, Yücel, A. Eftal, Arulmani, Udayasankar, Richard, Dominik, Murphy, Valda, Sallstig, Peter, Schlesinger, Naomi
Rok vydání: 2010
Předmět:
Zdroj: Rheumatology. 49:i59-i61
ISSN: 1462-0332
1462-0324
DOI: 10.1093/rheumatology/keq717
Popis: Background: Various modalities of treatment have been used and recommended in the treatment of acute gout. These include drugs such as colchicine, NSAIDs and oral prednisolone. Intramuscular depot methylprednisolone (im MP) is currently used in the treatment of rheumatoid arthritis as well as polymyalgia. However the response to im MP in acute gouty arthritis in an inpatient setting (where there are usually contraindications to NSAIDs) has not been previously described in literature. Methods: Eighteen case records of patients presenting with acute gouty arthritis and referred to Rheumatology, between October 2008 and October 2009, were reviewed. Results: Fourteen men and four women, with a mean age of 60 years (range 55-88 years) were seen. Of the 18, 14 patients had a previous history of chronic gout and 4 patients were newly diagnosed. Sixteen patients had polyarticular gout (mainly bilateral wrists and knees) and the remaining 2 had monoarticular gout (1 knee, 1 wrist). Seventeen patients had synovial fluid analysis, which revealed negatively birefringent urate crystals, and 1 patient refused joint aspiration. All patients had predisposing co-morbidities such as diabetes (10), hypertension (15), CCF (5), chronic kidney disease (8) and 2 patients had a history of chronic alcohol excess. Five patients initially received NSAIDs and 3 had concomitant colchicine with all 5 showing a delayed response. All patients were given im MP 120 mg in the gluteal region as a deep injection. All responded completely to im yMP within 2 days with resolution of pain and swelling of inflamed joints. All patients felt much improved and rated the treatment highly. Conclusions: The latest BSR guidelines recommends the use of steroids in the management of refractory cases of gout, i.e. patients intolerant of or having contraindications to NSAIDS or colchicine. This restricted indication is based mainly on the side effects to oral steroids or lack of expertise with intra-articular injections. We have shown that a single intramuscular methyl prednisolone injection is highly effective, very convenient, patient acceptable and safe treatment for gout particularly in elderly patients with multiple co-morbidities. As most cases of inpatient gout have comorbidities such as in our series with contraindications to NSAIDs, we recommend the use of im methyl prednisolone as the first-line treatment in such patients. It may be a less painful alternative to intra-articular steroid injections and safer than bigger doses of oral steroids (especially in diabetes). Disclosure statement: All authors have declared no conflicts of interest
Databáze: OpenAIRE
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