"May 2016, white male 51 yrs old, first gout attack. I was lifting heavy about 2 weeks ago and I over did red meat, chicken, salmon, two protein shakes per day at 30 grams each, aspirin almost daily and a 5 hour energy drink, junk food in there for good measure. Drink instant coffee excessively daily Did not like to drink water so likely became hydrated as well. I feel I brought this on with my eating habits but blood test came back uric acid which was within normal range. I in total pain and missed 2 weeks of work. Doctor put me on Indomethacin after weeks of Advil, water, cherries, cherry juice, no red meat or alcohol, etc with no relief. Felt relief first hour. Did get a little dizzy but pain is almost gone after 1st pill."
The most important determinant of therapeutic success is not which NSAID is chosen, but rather how soon NSAID therapy is initiated. In more than 90 percent of patients, complete resolution of the attack occurs within five to eight days of initiation of therapy. 18 Unfortunately, the use of NSAIDs is limited by side effects. NSAID therapy should be avoided in patients with peptic ulcer disease, low creatinine clearance, liver disease and poorly compensated congestive heart failure, and in patients receiving anticoagulation therapy. 19 , 20 Side effects of NSAIDs are also more pronounced in elderly patients. 21
Acute gout attacks can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids (intra-articular injection or systemic). All three agents are appropriate first-line therapy for acute gout. Therapy should be initiated within 24 hours of onset. The drug selection is dictated by the patient's tolerance of those medications and the presence of any comorbid diseases that contraindicates the use of a specific drug. For patients with severe or refractory gout attacks, practitioners can try combining agents. If all of these medications are contraindicated in a patient, narcotics may be used short term to relieve pain until the acute attack has resolved. Long-term use of narcotics should be avoided.