Which medications in the drug class Corticosteroids are used in the treatment of Gout and Pseudogout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Corticosteroids

Corticosteroids are potent and effective anti-inflammatory drugs that can be used to treat acute gout in patients who cannot tolerate NSAIDs or colchicine. They can be given orally, intramuscularly (IM), intravenously (IV), or intra-articularly. Adrenocorticotropic hormone (ACTH) also acts in gout, in part by inducing adrenal steroids. No intrinsic advantage to treating with IV corticosteroids exists unless the patient cannot take oral medications.

The short-burst corticosteroid regimen used to treat an acute flare of gout is generally well tolerated. Nevertheless, patients may experience the adverse effects seen with long-term steroid use.

In patients with only 1 or 2 involved joints, intra-articular corticosteroids are a safe and effective treatment option, once infection has been excluded. Water-soluble steroids (eg, dexamethasone) are teleologically inappropriate for use as a depot steroid treatment.

Prednisone (Deltasone, Prednisone Intensol, Rayos)

Oral prednisone can be given to abort an attack of gout. By reversing increased capillary permeability and suppressing polymorphonuclear leukocyte (PMN) activity, this agent may decrease inflammation. Steroid dose packs that clearly label the dose to be taken each day can be convenient for some patients.

Triamcinolone (Kenalog, Zilretta)

Intra-articular use is considered by some as the treatment of choice for pseudogout and for acute gouty attacks in patients who cannot be given NSAIDs, colchicine, or high-dose systemic corticosteroids.

Corticotropin (HP Acthar)

Corticotropin stimulates endogenous production of corticosteroids and directly and rapidly acts on peripheral leukocyte activation. It decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.


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