From the Guidelines
NSAIDs are a recommended first-line treatment for acute gout flares, with options including indomethacin, naproxen, and ibuprofen, as they have been shown to be effective in reducing pain and inflammation 1. When selecting an NSAID for gout treatment, it is essential to consider the patient's individual characteristics, such as renal disease, heart failure, or cirrhosis, as these conditions may contraindicate the use of NSAIDs 1. Some key points to consider when using NSAIDs for gout include:
- Indomethacin, naproxen, and ibuprofen are commonly used NSAIDs for gout treatment, with no evidence suggesting that one is more efficacious than the others 1
- Patients should be cautious when using NSAIDs, especially those with kidney disease, heart failure, hypertension, or a history of peptic ulcer disease 1
- NSAIDs do not prevent future gout attacks or lower uric acid levels, so they should be used alongside lifestyle modifications and potentially urate-lowering therapy for long-term management of gout 1 It is crucial to weigh the benefits and risks of NSAID use in each patient, considering their individual needs and medical history, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life 1.
From the FDA Drug Label
In patients with acute gout, a favorable response to naproxen was shown by significant clearing of inflammatory changes (e.g., decrease in swelling, heat) within 24 to 48 hours, as well as by relief of pain and tenderness. Naproxen can be used to treat acute gout. It has been shown to provide relief from pain and tenderness, as well as reduce inflammatory changes within 24 to 48 hours 2.
- Key benefits: relief of pain and tenderness, reduction of inflammatory changes
- Onset of action: within 24 to 48 hours Note that the use of naproxen for chronic gout management or gout prevention is not directly addressed in the provided label.
From the Research
NSAID Treatment for Gout
- NSAIDs are commonly used for the treatment of acute gout, but caution is required due to their adverse effects, especially in the elderly 3.
- Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine 4, 5.
- Low-certainty evidence suggests that NSAIDs may improve pain at 24 hours and may have little to no effect on function, inflammation, or adverse events for treatment of acute gout 6.
- Moderate-certainty evidence shows that COXIBs and non-selective NSAIDs are probably equally beneficial with regards to improvement in pain, function, inflammation, and treatment success, although non-selective NSAIDs probably increase withdrawals due to adverse events and total adverse events 6.
- Guidelines agree that anti-inflammatory treatment should start as soon as possible, preferably within 24 hours, and the choice of agent (NSAIDs, colchicine, or steroids) is left to the physician 7.
Comparison of NSAIDs with Other Treatments
- NSAIDs probably result in little to no difference in pain, inflammation, function, or treatment success compared to glucocorticoids 6.
- Non-selective NSAIDs probably increase withdrawals due to adverse events and total adverse events compared to COXIBs 6.
- There is no difference in inflammation between NSAIDs and glucocorticoids 6.
Guidelines and Recommendations
- Guidelines recommend treating to target of serum urate (sUA) less than 6 mg/dl, and less than 5 mg/dl for patients with more severe disease 7.
- Concurrent anti-inflammatory prophylaxis has gained strong support over the years 7.
- Most guidelines are in agreement with recommendations for management of gout, and most changes have been directional and evolutionary 7.