ABSTRACT
Nonsteroidal anti-inflammatory drugs [NSAIDs] are currently the most fivored treatment of acute microcrystalline arthritis: acute gout, acute pyrophosphate arthritis [acute pseudogout], and acute calcific periarthritis. Although coichicine has been widely used for a long time with considerable efficacy, its therapeutic utility is limited by its narrow benefit-to-toxicity ratio. The management of acute microcrystalline events can be difficult in aged patients, and in those with medical illnesses contraindicating therapy with either NSATDs or colchicine. Intraarticular corticosteroid therapy is particularly useful for the treatment of acute mono- or oligo-articular microcrystalline synovitis in these patients. Oral prednisone and both parenteral corticotropin [ACTI-l] and corticosteroids [triamcinolone acetonide and methylprednisolone acetate] are useful alternate therapeutic modalities in those with acute polyarticular microcrystalline attacks. Although ACTH has demonstrated comparable clinical efficacy to corticosteroids, its use is limited by a number of factors: need for parenteral administration, difficulty delivering a precise dose, dependence of therapeutic effects on adrenocortical responsiveness, a relatively short duration of action and a higher incidence of hypertension and fluid overload