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Non-steroidal Anti-inflammatory Drugs
NSAIDs work by suppressing the production of fatty acids called prostaglandins that cause the inflammation and pain of gout. They do this by blocking the action of an enzyme, cyclooxygenase (COX). This enzyme is responsible for converting precursor acids into prostaglandins.
Although over-the-counter NSAIDs are good options to relieve minor pain, people with acute gout attacks that are severe and not relieved by over-the-counter NSAIDs can receive prescription strength NSAIDs from a physician. Many NSAIDs are now available as generic products and thus are a less expensive treatment option for acute gouty attacks.
One important factor to consider is that traditional NSAIDs can have side effects, including diarrhea, headache, confusion, worsening of hypertension, and fluid retention. The most potentially dangerous side effects are gastric irritation and bleeding, which can occur without the patient being aware that this is happening. Thus, it is important for regular NSAID consumption to be monitored by a physician.
Although NSAIDs are widely prescribed and available, it has long been known that they can produce side effects. The cause of these side effects has only been discovered recently, when, in the early 1990s, researchers demonstrated that there are actually two COX enzymes, dubbed COX-1 and COX-2. They are so similar in structure that NSAIDS interact with both of them. However, the COX-1 enzyme does not play a role in inflammation and pain. It is found throughout the body, especially in the gastrointestinal tract, kidneys, and blood platelets. It is believed that blocking this COX-1 enzyme leads to the stomach and kidney damage that NSAIDs can cause. By comparison, COX-2 is found primarily in inflamed tissue. With this finding, pharmaceutical companies have produced many medications that only interact with COX-2. These are called COX-2 inhibitors, and it is hoped that they can prove to be as effective as NSAIDs without the common side effects.
Although COX-2s have been shown to be effective for the treatment of pain (but have not been specifically studied for treating acute gout attacks) they may have damaging effects to the heart. Vioxx, a member of this class of drugs, was removed from the market because of heart related risks. It was shown to increase the risk of heart disease.
Currently other COX-2 inhibitors (that have not been definitively shown to produce heart related risks) are available but are not considered first-line therapy for gout. These drugs are an expensive means to treat gout attacks. A traditional NSAID should be tried first in most individuals.
Many NSAIDs are now available without a prescription or as generic products. Medications that protect the stomach can be prescribed with NSAIDs.
The first COX-2 inhibitor, Celebrex (celecoxib, Searle), was approved by the United States Food and Drug Administration in December, 1998 to treat osteoarthritis and rheumatoid arthritis. A second COX-2 inhibitor, Vioxx, developed by Merck, was approved but then was pulled off of the market due to adverse effects on the heart. Use of Celebrex may be limited until the long term effectiveness and safety of COX-2 inhibitors are established. However, in the long run, observers believe they are likely to become major clinical advances in the management of pain and arthritis.
Drugs in the class
Diclofenac Potassium Tablets
(
Cataflam Tablets
)
Etodolac Capsules
Fenoprofen Capsules
(
Fenoprofen Calcium Capsules,
Nalfon Capsules
)
Ibuprofen Tablets
(
Advil Caplets,
Advil Gel Caplets,
Advil Junior Strength Tablets,
Advil Tablets,
Genpril Tablets,
IBU Tablets,
Ibu-200 Tablets,
Motrin IB Tablets,
Motrin Junior Strength Caplets
)
Indomethacin Capsules
Ketoprofen Capsules
Naproxen Tablets
(
Naprosyn Tablets
)
Oxaprozin Tablets
(
Daypro Tablets
)
Piroxicam Capsules
(
Feldene Capsules
)
Sulindac
(
Clinoril
)
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