Can meloxicam (nonsteroidal anti-inflammatory drug (NSAID)) help with gout?

Can Meloxicam Help with Gout?

Yes, meloxicam can effectively treat acute gout attacks when used at full anti-inflammatory doses (15 mg once daily), though it is not specifically FDA-approved for gout and may be less effective than some other NSAIDs like rofecoxib or indomethacin. 1, 2

Evidence for Meloxicam in Acute Gout

Efficacy Data

• Meloxicam demonstrated inferior efficacy compared to rofecoxib in a head-to-head trial, with only 40% of meloxicam patients showing good response on day 3 versus 84.2% with rofecoxib (P=0.005), and 60% versus 94.7% on day 8 (P=0.02). 3

• Despite this, meloxicam still provided significant improvement in inflammatory scores from baseline when used at 15 mg once daily for 7 days in acute gout patients. 3

• High-quality evidence confirms that NSAIDs as a class reduce pain in acute gout, and meloxicam functions as a selective COX-2 inhibitor with proven anti-inflammatory properties. 1, 4

Positioning Among Treatment Options

• NSAIDs (including meloxicam) are recommended as first-line therapy for acute gout attacks, alongside colchicine and corticosteroids, with treatment ideally initiated within 24 hours of symptom onset. 1, 5, 6, 2

• The American College of Physicians specifically lists FDA-approved NSAIDs for acute gout as naproxen, indomethacin, and sulindac—notably, meloxicam is not on this FDA-approved list. 2

• Moderate-certainty evidence shows that selective COX-2 inhibitors (like meloxicam) and non-selective NSAIDs are probably equally beneficial for pain relief, function, and treatment success in acute gout. 4

Practical Dosing and Administration

• Meloxicam should be administered at 15 mg once daily (the full anti-inflammatory dose) for acute gout treatment. 3

• Treatment should be continued for 7 days or until symptom resolution. 3

• The 20-hour half-life makes once-daily dosing convenient and appropriate. 7

Safety Profile and Advantages

• Meloxicam offers superior gastrointestinal tolerability compared to non-selective NSAIDs due to its COX-2 selectivity, with significantly fewer GI adverse events. 1, 4, 7

• In the comparative trial, meloxicam was well tolerated with only 28.6% of patients reporting adverse events (primarily edema and abdominal discomfort), similar to other NSAIDs. 3

• Meloxicam does not compromise renal function in patients with mild pre-existing renal impairment and shows no drug accumulation with continued use. 8, 7

Critical Contraindications

• Avoid meloxicam in patients with severe renal impairment (CKD stage 4 or worse), active GI bleeding or ulceration, heart failure, or cirrhosis. 5, 2

• NSAIDs should be avoided in patients with chronic kidney disease, congestive heart failure, or peptic ulcer disease. 5, 2

Common Pitfalls to Avoid

• Do not delay treatment—initiating NSAIDs beyond 24 hours of symptom onset significantly reduces effectiveness. 5, 6, 2

• Do not use subtherapeutic doses—meloxicam must be used at 15 mg daily, not the lower 7.5 mg dose, for acute gout. 3

• Do not discontinue urate-lowering therapy during an acute attack if the patient is already taking it—continue the ULT and treat the flare separately. 6, 2

Alternative First-Line Options

• If meloxicam is contraindicated or ineffective, consider:

  • Indomethacin 50 mg three times daily for 2-3 days, then 25 mg three times daily 2
  • Naproxen at full anti-inflammatory doses 2
  • Oral corticosteroids (prednisone 30-35 mg daily for 3-5 days) 5, 6
  • Low-dose colchicine (1.2 mg followed by 0.6 mg one hour later) if started within 36 hours 5, 6, 2

• Corticosteroids are increasingly recommended as first-line therapy due to their safety profile and cost-effectiveness, particularly in patients with multiple NSAID contraindications. 5, 6