[Insufficient evidence for oral glucocorticoids as first-line therapy for acute gout]

In a recent equivalence clinical trial, prednisolone was reported to be equally effective as naproxen in the treatment of acute gout arthritis. The authors stated that the study provides a strong argument to consider prednisolone as first-line therapy for acute gout. For this double-blind placebo-controlled trial patients with the clinical diagnosis of acute gout (n = 381) were referred from primary care centers, but only those patients with crystal-proven gout and absence of contraindications for the trial medication were included (n = 120). They were randomly assigned to oral treatment for 5 days with either once-daily prednisolone 35 mg or twice-daily naproxen 500 mg and respective placebos. Points of discussion are whether there was indeed equivalence in effect, whether equivalence in adverse effects of the two treatments can be determined from the trial or from literature, and whether the results may be generalised. Although in selected acute gout patients prednisolone may be a good choice, available data still are too scarce to conclude that oral prednisolone is the first-line therapy for gout arthritis.