Reachout Orthopedics - Issue 1

EFFICACY AND SAFETY OF ETORICOXIB COMPARED WITH NSAIDs IN ACUTE GOUT: A SYSTEMATIC REVIEW AND A META-ANALYSIS A cute gouty arthritis is the most common form of in- flammatory joint disease in males over 40 years [1]. It is estimated that 0.5–2.8 % of males have suffered from this disease, while there is a lower incidence among females [2]. One third of female patients suffering from gout are premenopausal and have an unexpectedly high prevalence of lithiasis [3]. Epidemiologic evidence suggests that the in- cidence of gout is steadily increasing and is connected with longevity, obesity, coexist- ing comorbidities, and iatrogenic causes that contribute to hyperuricemia such as diuretic use [4]. The prevalence is much higher among individuals with a positive family history [2], but the precise mechanism is unclear. The primary symptom of acute gouty arthritis is pain and typically involves smaller appen- dicular joints like the metatarsophalangeal joints [5]. Therapy is directed at controlling inflammation and relieving joint pain [6]. Treatments aimed at modulating the inflam- matory process have changed little over the last 40 years [7], and there are still limita- tions in controlling inflammation and reliev- ing pain. In 2012, the American College of Rheumatology Guidelines for Management of Gout [8] recommended multiple modali- ties (non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids by different routes, and oral colchicines) as appropriate initial therapeutic options for acute gout attacks. For NSAIDs, they recommend naproxen, indomethacin, and sulindac. However, the guidelines do not recommend a specific NSAID for first-line treatment, cyclooxyge- nase 2 (COX-2) inhibitors are an option for patients with gastrointestinal contraindica- tions or intolerance to NSAIDs. Several ran- domized controlled trials (RCTs) have been published that support the efficacy of COX-2 inhibitors like etoricoxib, lumiracoxib, and celecoxib [9–11]. However, there is still not much evidence to indicate efficacy of these Shaobo Zhang 1 , Yibao Zhang 1 , Peng Liu 1 , Wei Zhang 1 , Jing-lin Ma 1 , Jing Wang 1,2 * 1  Key Laboratory of Orthopedics of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou University, No. 82 Cui Ying Men Street, Lanzhou, Gansu 730030, People’s Republic of China 2  Department of Orthopedics, The Second Hospital of Lanzhou University, No. 82 Cui Ying Men Street, Lanzhou, Gansu 730030, People’s Republic of China *wangjing1mail@163.com; wang_jing@lzu.edu.cn Therapeutic Update Acute gouty arthritis is the most common form of inflammatory joint disease. The primary symptom of acute gout is pain. Optimal therapy is directed at controlling inflammation and analgesia. The aim is to study the efficacy and safety of etoricoxib in the treatment of acute gout, as compared with non-steroidal anti- inflammatory drugs (NSAIDs). 8