Limited evidence supported the use of NSAIDs in the treatment of acute gout. One placebo-controlled trial provided evidence of benefit at 24 hours and little or no harm. We downgraded the evidence due to potential selection and reporting biases, and imprecision. While these data were insufficient to draw firm conclusions, they did not conflict with clinical guideline recommendations based upon evidence from observational studies, other inflammatory arthritis and expert consensus, which support the use of NSAIDs in acute -quality evidence suggested that selective COX-2 inhibitors and non-selective NSAIDs are probably equally beneficial although COX-2 inhibitors are likely to be associated with significantly fewer total and gastrointestinal adverse events. We downgraded the evidence due to an unclear risk of selection and reporting biases. Moderate-quality evidence indicated that systemic glucocorticoids and NSAIDs were also equally beneficial in terms of pain relief. There were no withdrawals due to adverse events and total adverse events were similar between groups. We downgraded the evidence due to unclear risk of selection and reporting bias. There was low-quality evidence that there was no difference in function. We downgraded the quality due to unclear risk of selection bias and imprecision.
A newer type of NSAID available is known as the COX-2 inhibitor. COX-2 inhibitors provide the anti-inflammatory effects of blocking the COX-2 enzyme, but do not affect the COX-1 enzyme, reducing the risk of stomach or intestinal damage. COX-2 inhibitors are ideal for patients who are considered to be at an elevated risk for developing stomach or intestinal problems; however, COX-2 inhibitors can increase the risk for damage to the heart, and thus, are not ideal for patients with problems with circulation or other types of heart conditions.
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