@Anking-maintainers I like the suggestion better than the original because it goes into more detail. AMBOSS does state that āGlucocorticoids are preferable if there are contraindications (e.g., CKD), intolerance, or inadequate response to colchicine or NSAIDs,ā implying that steroids are third-line. However, AMBOSS also states that āColchicine is preferable in patients who cannot tolerate NSAIDs or systemic glucocorticoids (e.g., patients with gastrointestinal ulcers),ā implying that colchicine is third-line. So to me, it seems that rather than the original hierarchy of NSAIDS > colchicine > steroids, it would be more accurate to characterize it as NSAIDs > colchicine = steroids, with the latter two both being second-line treatments. Further complicating matters, the ātherapy of acute goutā table in the article shows no prioritization of nsaids over colchicine, with both being appropriate choices for an acute gouty attack with severe pain or more than 4 joints or 1 large joint. In summary I think that @mohannadkh10 's suggestion is a reasonable summary of the info from the article and that either nsaids > colchicine = steroids or āall three are first-lineā is appropriate.
Thank you for the detailed response.
I want to add that I have seen one of the Step 1 UWorld questions stating that NSAIDs are the preferred agents over colchicine and steroids.
I need to look more into what UWorld says, especially in Steps 2 and 3, before proceeding with this (I will do this later today or tomorrow)
The current bulk suggestion aligns with AMBOSS and UpToDate
I know there is no resource provided for this suggestion, but it was made following a discussion in another suggestion that highlighted the need for a change in the hierarchy
Just checked tagged NBME FM form 5. Steroids and NSAIDs are both answer choices for acute gout and āindomethacinā is the right answer. Educational objective states that NSAIDS are preferred over Steroids (due to the side effect profile)
what do you think about nsaids > steroids = colchicine
Actually the QID goes out of its way to say that the patient responded bad to colchicine. And then it implies in the explanation that it seems to be equal or a close second to NSAIDs. Soā¦IMO the card is fine as is
ok Iām fine with rejecting then
I would prefer if we keep it open for now, I understand that this is not the best solution but the card still needs a change
maybe take it to slack? I feel like otherwise itās just going to sit in limbo for months-a year
Personally, I donāt think so, but definitely feel free to bring it to slack.