The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding).
A Cochrane review [Abstract] 1 included 28 studies with a total of 3 406 subjects. The aim of the review was to assess the benefit and safety of non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 inhibitors (COXIBs) for acute gout. One study (n=30) compared NSAIDs to placebo, 6 (n=1 244) compared non-selective NSAIDs to selective cyclo-oxygenase-2 (COX-2) inhibitors (COXIBs), 5 (n=712) compared NSAIDs to glucocorticoids, 13 compared one NSAID to another NSAID (n=633), and single trials compared NSAIDs to rilonacept (n=225), acupuncture (n=163), and colchicine (n=399).
Main results for the comparison of NSAID (tenoxicam) versus placebo are shown in table T1.
Non-selective NSAIDs compared to COXIBs resulted in little to no difference in pain (MD 0.03, 95% CI -0.07 to 0.14; 6 studies), swelling (MD 0.08, 95% CI -0.07 to 0.22; 6 studies), treatment success (MD 0.08, 95% CI -0.04 to 0.2; 4 studies, n=730), or quality of life (1 study). Non-selective NSAIDs increased withdrawals due to adverse events (RR 2.3, 95% CI 1.3 to 4.1; 6 studies, n=1 243) and total adverse events (mainly gastrointestinal; RR 1.9, 95% CI 1.4 to 2.8; 6 studies, n=1 232) compared to COXIBs.
| Outcome | Relative effect (95% CI) | Assumed risk - placebo | Corresponding risk - NSAID (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Pain improvement by 50% in 24 hours | RR 2.75 (1.13 to 6.72) | 26.7% | 73.3% (30.1 to 100)) | 30 (1 study) |
| Inflammation - joint swelling improvement | RR 1.08 (0.79 to 1.49) | 80.0% | 86.4% (63.2 to 100) | 30 (1 study) |
| Adverse events | RR 0.2 (0.01 to 3.85) | 13.3% | 2.7%(0.1 to 51.3) | 30 (1 study) |
NSAIDs resulted in little to no difference in pain, inflammation, function, or treatment success compared to glucocorticoids. There was no difference in withdrawals due to adverse events with NSAIDs compared to glucocorticoids (RR 2.8, 95% CI 0.5 to 14.2; 5 studies, n=772), but there was a decrease in total adverse events with glucocorticoids compared to NSAIDs (RR 1.6, 95% CI 1.0 to 2.5; 5 studies, n=753).
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