Background ACR and EULAR recommendations in management of gout flares with oligoarticular involvement points that systemic corticosteroids should be strongly considered in patients with oligoarticular gout flares. However, some considerations must be taking into account before been used, especially in diabetic patients with an unstable glycemic control of with history of hyperglycaemic states after corticoids administration. Instead of avoiding its use, some clinicians use doses lesser than recommended in such patients with different results.
Objectives To compare the effectiveness of different doses of corticoids in diabetic patients with acute oligoarticular gout flares fixed to weight and colchicine doses.
Methods An observational retrospective study was performed. Electronic charts of diabetic patients who consulted to our A&E department from 2013 and 2015 and were diagnosed by oligoarticular gout flare were identified and revised. Registries included patients with oligoarticular gout flares who were not treated with parenteral corticoids or joint infiltrations. They were grouped according to the corticoids dose received fixed by weight and colchicine treatment. Main outcome variables were: need of further consultation before 14th day, VAS-pain score at 7th and 14th day, hyperglucemic states and time off work, where applied. Treatments with systemic corticoids were classified in two arbitrary groups: up to 0.30mg/kg/day (Group I) and 0.31 to 0.49mg/kg/day (Group II). Patients who were treated with higher doses were considered regular doses and were excluded.
Results During the period of observation, 81 registries of diabetic patients diagnosed by gout flares with more than a joint involved were detected. Among them, only 62 had complete registries of weight (diabetic control at primary care facility) and complete follow up assessment after gout flare. 29 and 32 patients were included in groups I and II, respectively. Table 1, summarizes the results of the study.
Conclusions In diabetic patients with oligoarticular or polyarticular gout flares the therapeutic approach with prednisone doses higher than 0.3mg/kg/day seems to be associated with a lower tendency of need of new clinical assessment, and a better pain control without a higher frequency of hyperglucemic states.
Disclosure of Interest None declared
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