From the University of Sydney, Sydney, Australia; Diaverum Medical Scientific Office and Diaverum Academy, Lund, Sweden; Amedeo Avogadro University of Eastern Piedmont, Novara; University of Bari, Bari, Italy; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
C.A. Billy, MD, MMed (ClinEpi), University of Sydney; R.T. Lim, B-BMED, University of Sydney; M. Ruospo, MscMed, Diaverum Medical Scientific Office and Amedeo Avogadro University of Eastern Piedmont; S.C. Palmer, MB ChB, PhD, Department of Medicine, University of Otago, Christchurch; G.F. Strippoli, MD, PhD, University of Sydney, Diaverum Medical Scientific Office, University of Bari, and Diaverum Academy.
J Rheumatol. 2018 Jan;45(1):128-136. doi: 10.3899/jrheum.170137. Epub 2017 Aug 1.
Nonsteroidal antiinflammatory drugs (NSAID) are used as first-line agents to treat acute gout. Recent trials suggest a possible first-line role for corticosteroids.
We conducted a metaanalysis of randomized controlled trials (RCT) evaluating corticosteroid versus NSAID therapy (nonselective and selective) as treatment for acute gout. MEDLINE, EMBASE, and CENTRAL were systematically searched through August 2016. Outcomes included pain, bleeding, joint swelling, erythema, tenderness, activity limitation, response to therapy, quality of life, time to resolution, supplementary analgesics, and adverse events. Evidence quality was summarized using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system.
Six eligible trials (817 patients) were identified. The mean study followup was 15 days (range 4-30). Risks of bias were generally low. In low- to moderate-quality evidence, corticosteroids did not have different effects on pain score at < 7 days [standardized mean difference (SMD) -0.09, 95% CI -0.26 to 0.08] or at ≥ 7 days (SMD 0.32, 95% CI -0.27 to 0.92) when compared with NSAID. There was no evidence of different risks of gastrointestinal bleeding [relative risk (RR) 0.09, 95% CI 0.01-1.67]. There was no evidence of different responses to therapy on pain at < 7 days (RR 1.07, 95% CI 0.80-1.44) and ≥ 7 days, time to disease resolution, or number of supplementary analgesics used (MD 2.10 drugs, 95% CI -1.01 to 5.21). There was a lower risk of indigestion (RR 0.50, 95% CI 0.27-0.92), nausea (RR 0.25, 95% CI 0.11-0.54), and vomiting (RR 0.11, 95% CI 0.02-0.56) with corticosteroid therapy.
There is no evidence that corticosteroids and NSAID have different efficacy in managing pain in acute gout, but corticosteroids appear to have a more favorable safety profile for selected adverse events analyzed in existing RCT.
非甾体抗炎药（NSAID）被用作治疗急性痛风的一线药物。最近的试验表明，皮质类固醇可能具有一线作用。
我们对评估皮质类固醇与 NSAID（非选择性和选择性）治疗急性痛风的疗效的随机对照试验（RCT）进行了荟萃分析。通过系统检索 MEDLINE、EMBASE 和 CENTRAL，检索时间截至 2016 年 8 月。结局包括疼痛、出血、关节肿胀、红斑、触痛、活动受限、治疗反应、生活质量、缓解时间、辅助镇痛剂和不良事件。使用 GRADE（推荐评估、制定与评价）系统总结证据质量。
共纳入 6 项符合条件的试验（817 例患者）。平均研究随访时间为 15 天（范围 4-30 天）。偏倚风险通常较低。在低至中等质量证据中，与 NSAID 相比，皮质类固醇在 <7 天时（标准化均数差[SMD] -0.09，95%CI -0.26 至 0.08）或在 ≥7 天时（SMD 0.32，95%CI -0.27 至 0.92）对疼痛评分的影响没有差异。胃肠道出血风险无差异[相对风险（RR） 0.09，95%CI 0.01-1.67]。在 <7 天（RR 1.07，95%CI 0.80-1.44）和 ≥7 天、治疗反应、疾病缓解时间或使用辅助镇痛剂数量方面，皮质类固醇和 NSAID 对疼痛的疗效无差异（MD 2.10 种药物，95%CI -1.01 至 5.21）。皮质类固醇治疗的消化不良（RR 0.50，95%CI 0.27-0.92）、恶心（RR 0.25，95%CI 0.11-0.54）和呕吐（RR 0.11，95%CI 0.02-0.56）风险较低。
皮质类固醇和 NSAID 在治疗急性痛风疼痛方面的疗效没有证据表明有差异，但皮质类固醇在现有 RCT 分析的选择不良事件方面具有更有利的安全性。
