I read with interest your learning article on gout (
The Pharmaceutical Journal, 2014;293:182). However, I am rather confused over the reference to using non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of acute gout. I was always under the impression that ibuprofen should not be used in the treatment of acute gout but in the article the author says there is no convincing evidence that any NSAID is better than another.
A quick look at the British National Formulary (BNF) found: “Ibuprofen is a propionic acid derivative with anti-inflammatory, analgesic, and antipyretic properties. It has fewer side effects than other non-selective NSAIDs but its anti-inflammatory properties are weaker. Doses of 1.6g to 2.4g daily are needed for rheumatoid arthritis and it is unsuitable for conditions where inflammation is prominent, such as acute gout.”
So does this mean the BNF is wrong and this should be removed, or is it just the author’s opinion that there is no difference between different NSAIDs in the treatment of acute gout? When I looked online it appears many websites do suggest that ibuprofen can be used for acute gout, but NHS Choices agrees with BNF advice.
Michael Franks
Highgate
Tina Hawkins, author of “Acute management and treatment of gout”, responds: In the article I was referring to the specific NSAIDs licensed for acute gout and where trials have been performed. I was involved in producing the statement in the BNF that ibuprofen is not recommended in acute gout and, to clarify, in those NSAIDs licensed for the acute management of gout there is no convincing evidence that one of these agents should be used in preference to another. Sorry for any confusion caused.
