Indomethacin

Indomethacin is a potent NSAID that has been widely used for treating acute gout attacks. It rapidly reduces pain and inflammation by inhibiting both cyclooxygenase-1 and cyclooxygenase-2 enzymes. A classic study by Smyth and Percy (1973) demonstrated the superior efficacy of indomethacin compared to phenylbutazone in managing acute gout. More recently, a randomized trial by Schumacher et al. (2012) showed that indomethacin was as effective as the selective COX-2 inhibitor etoricoxib for acute gout treatment. However, indomethacin is associated with a higher risk of gastrointestinal and central nervous system side effects compared to other NSAIDs. A systematic review by Zhang et al. (2014) found that indomethacin had a less favorable safety profile than other NSAIDs in gout treatment. Due to these concerns, indomethacin is often reserved for severe acute gout attacks or when other NSAIDs have proven ineffective.