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COX-2 Inhibitors for Gout? The Answer's Not Crystal Clear

COX-2 Inhibitors for Gout? The Answer's Not Crystal Clear

Can cyclooxygenase (COX)-2 inhibitors be used to treat gout?
-- Fred Z. Havens, MD
    Riverside, Calif
The COX-2 inhibitors reduce inflammation while producing less GI toxicity than traditional NSAIDs. The efficacy of COX-2 inhibitors has been tested in patients with rheumatoid arthritis (RA), osteoarthritis (OA), dental pain, postoperative pain, and dysmenorrhea--and is equivalent to that of traditional NSAIDs. COX-2 inhibitors have not been formally studied in acute gout; thus, there is no evidence-based answer to your question. Nonetheless, one would intuitively expect these agents to be as effective as traditional NSAIDs for treatment of the inflammation associated with gout; there is anecdotal evidence that they are. The main reasons for prescribing a COX-2 inhibitor for a patient with acute gout would be a history of GI intolerance with traditional NSAIDs or the presence of other risk factors for peptic ulceration. The efficacy of COX-2 inhibitors would probably be no greater than that of traditional NSAIDs at recommended doses.
-- Sharon Van Doornum, MD
    Department of Rheumatology
    Alfred Hospital
    Prahran, Victoria

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