Journal Club
September Journal Club

September 23 (Thursday)
6:30 PM
5510 Cramblet Hall Conference Room

Journal Club Vignette

A 45 year old male comes in to the ED complaining of severe pain in his toe. He has a history of similar events about 2 years ago but does not recall what it was attributed to. He states over the weekend he was at a cookout where he had eaten a couple of cheeseburgers and had several cold beers. He recalls the prior event occurring after consuming an excessive amount of alcohol as well. He denies any trauma or injury. He denies any fevers. He has a history of hypertension for which he takes HCTZ. On exam, he is afebrile with normal vital signs. Exam of his right foot shows a warm, erythematous, exquisitely tender great toe on the right at the 1st MTP joint. You astutely diagnose the patient with Gout and want to institute the safest and most effective treatment for your patient. Classically, the treatment of Gout is centered around NSAIDs but you are unsure if that is the ideal treatment or not.

To investigate this, the following approach is explored:

PICO Question

Population: Adults with acute gout
Intervention: Steroids and/or Colchicine
Comparison: NSAIDs
Outcome: Decreased pain, repeat ED visits, hospitalizations


Search Strategy: Pubmed; Keywords: gout AND treatment AND acute Limits: English, adults, last 5 years Results: 89 articles. 3 selected for review
First years: High Versus Low Dosing of Oral Colchicine for Early Acute Gout Flare: Terkeltaub et al. (Pub Med Link) Arthritis and Rheumatism April 2010.

Article Critique
Second years: Comparison of Oral Prednisolone/Paracetamol and Oral Indomethacin/Paracetamol Combination Therapy in the Treatment of Acute Gout-like Arthritis: A Double-Blind, Randomized, Controlled Trial: Man et al. (Pub Med Link) Annals of EM May 2007

Article Critique
Third years: Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomized equivalence trial: Janssens, et al. (Pub Med Link) Lancet May 2008

Article Critique
All years use the "RCT Critical Review Form" (Download)


Extra Articles: EULAR evidence based recommendations for gout. Part I: W Zang, et. al. Ann Rheum Dis 2006;65:1301–1311.

Download Article

EULAR evidence based recommendations for gout. Part II: W Zang, et. al. Ann Rheum Dis 2006;65:1312–1324.

Download Article
© Ohio State University Department of Emergency Medicine