COMPARISON OF ADRENOCORTICOTROPIC HORMONE AND TRIAMCINOLONE ACETONIDEIN THE TREATMENT OF ACUTE GOUTY-ARTHRITIS

Objective. To determine the best alternative therapy for acute gouty a rthritis when nonsteroidal antiinflammatory drugs or colchicine are co ntraindicated.. Methods. Thirty-one patients with crystal proven gout presenting with an acute attack of < 5 days' duration were treated pro spectively with either a single intramuscular injection of adrenocorti cotropic hormone (ACTH) 40 IU or triamcinolone acetonide 60 mg. The pa tients were followed for 30 days. Results. Resolution of all symptoms occurred at an average of X days for both groups. No adverse reactions were noted in either group; however, there were 11 reinjections in th e ACTH group and 5 reinjections in the triamcinolone acetonide group. Two patients from the ACTH arm were transferred to the triamcinolone a cetonide arm because of rebound arthritis. Conclusion. Although recent studies of ACTH and triamcinolone acetonide have demonstrated efficac y and safety comparable to indomethacin, in a direct comparison of the 2 at the doses used, triamcinolone acetonide resulted in fewer reboun d attacks and treatment failures than ACTH and required fewer reinject ions.