Current therapy of acute microcrystalline arthritis and the role of corticosteroids

The management of acute gout, and other acute microcrystalline arthritides, can be difficult in aged patients, and in those with multiple medical illnesses contraindicating therapy with either nonsteroidal anti-inflammatory drugs or colchicine. Intra-articular corticosteroid therapy is particularly useful for the treatment of acute mono-or oligo-articular micro-crystalline synovitis in these patients. Oral corticosteroids (e.g., prednisone), and both parenteral corticotrophin (adrenocorticotrophic hormone) (ACTH) and corticosteroids (e.g., triamcinolone acetonide, methylprednisolone acetate), are useful alternate treatment modalities in those patients with acute polyarticular attacks. Although ACTH has demonstrated comparable clinical efficacy to corticosteroids in the treatment of acute micro-crystalline events, corticosteroids are preferred by many physicians for many reasons: administration can be oral, dose can be regulated precisely, effectiveness does not depend on adrenocortical responsiveness, and incidence of certain side effects, such as hypertension and fluid overload, is lower.