Health Library Corticosteroids for GoutFrom Healthwise

These medications can be injected directly into the affected joint (intra-articular), in the muscle of the hip or buttock (intramuscular), or taken in pill form (oral). The dose of oral corticosteroids is gradually reduced over several days to 2 weeks until finished. Occasionally they are injected directly into a vein (intravenous).

Corticosteroids decrease the pain, swelling, redness, and warmth (inflammation) of gout.

Corticosteroids may be used for:

• Gout attacks that are limited to a single joint.¹
• Gout attacks that do not respond to nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine.
• People who cannot take NSAIDs or colchicine, such as those with kidney disease or a history of serious ulcer disease and gastrointestinal bleeding. Corticosteroids may also be used by people who have congestive heart failure or take the blood-thinner warfarin, or are allergic to aspirin.

Corticosteroids are not recommended for people who have a joint infection.

Corticosteroids usually provide rapid relief from gout symptoms.² Because of their potential side effects if used for a long time, corticosteroids are usually prescribed only for a short time.³

Common short-term side effects include:

• Mood swings.
• Nervousness.
• Insomnia.
• Weight gain.
• Fluid retention.
• Very rounded (moon) face.
• Poor wound healing.
• Increased risk of infection.
• High blood pressure.
• Diabetes.

Uncommon short-term side effects include:

• Muscle weakness.
• Glaucoma.
• Stomach ulcers.
• Acne.

Long-term side effects include:

• Osteoporosis.
• Cataracts (uncommon).
• Damage to the hip, shoulder, or knee joints (uncommon).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

• Corticosteroids are most often used in people who are unable to take nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine. If only one joint is affected, injection of corticosteroids into the joint may be most effective. If multiple joints are involved, corticosteroids may be injected into a vein or muscle or taken by mouth in pill form, in gradually decreasing doses.
• Corticosteroids should not be used when bacterial arthritis is present.
• People with high blood pressure should monitor their pressure while using corticosteroids.
• People with diabetes may need more medication or insulin when using corticosteroids to treat their gout.

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Citations

1. Wortmann RL, Kelley WN (2005). Gout and hyperuricemia. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., pp. 1402–1429. Philadelphia: Elsevier Saunders.

2. Klippel JH, et al. (1999). Gout section of Regional pain and monoarticular disorders. In Primary Care Rheumatology, pp. 117–124. London: Mosby.

3. Rott KT, Agudelo CA (2003). Gout. JAMA, 289(21): 2857–2860.

Author:	Jan Nissl, RN, BS	Last Updated: July 24, 2006
Medical Review:	Martin Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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