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

Can cyclooxygenase (COX)-2 inhibitorsbe used to treat gout?
-- Fred Z. Havens, MD
    Riverside, CalifThe COX-2 inhibitors reduceinflammation while producingless GI toxicity than traditionalNSAIDs. The efficacyof COX-2 inhibitors has beentested in patients with rheumatoidarthritis (RA), osteoarthritis (OA),dental pain, postoperative pain, anddysmenorrhea--and is equivalentto that of traditional NSAIDs. COX-2inhibitors have not been formallystudied in acute gout; thus, there isno evidence-based answer to yourquestion.Nonetheless, one would intuitivelyexpect these agents to be as effectiveas traditional NSAIDs for treatmentof the inflammation associatedwith gout; there is anecdotal evidencethat they are. The main reasons forprescribing a COX-2 inhibitor for a patientwith acute gout would be a historyof GI intolerance with traditionalNSAIDs or the presence of other riskfactors for peptic ulceration. The efficacyof COX-2 inhibitors would probablybe no greater than that of traditionalNSAIDs at recommendeddoses.
-- Sharon Van Doornum, MD
    Department of Rheumatology
    Alfred Hospital
    Prahran, Victoria
    Australia