***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Twenty-seven patients presenting within 5 days of the onset of crystalline proven acute gout were prospect ively treated with either indomethacin 50 mg tid or triamcinolone acetonide 60 mg intramuscularly . Patients with contraindications to therapy with indomethacin  received triamcinolone acetonide . They were followed for 30 days . Resolution of all symptoms occurred at an average of 8 days for the indomethacin patients and 7 days in the triamcinolone patients . No side effects or episodes of rebound gout attacks occurred with the triamcinolone acetonide therapy . It is as safe and effective as indomethacin in the treatment of acute gout , and is particularly useful in patients with contraindications to therapy with nonsteroidal antiinflammatory drugs A double-blind , parallel group study was carried out in 61 patients suffering from acute gouty arthritis to compare the effectiveness of etodolac and naproxen in the relief of symptoms . Patients were allocated at r and om to receive either 300 mg etodolac twice daily ( 31 patients ) or 500 mg naproxen twice daily ( 30 patients ) for 7 days . Both groups were comparable for sex , age and weight of patients , but there was a tendency for patients in the etodolac group to have more severe gout as shown by baseline clinical assessment scores . The variables assessed on entry and on Days 2 , 4 and 7 of treatment were pain intensity , swelling , tenderness , erythema , joint heat , range of motion , and physician 's and patients ' overall evaluation of the condition . The results showed that there was a significant improvement from baseline in all of the variables at each time point in both treatment groups . However , more etodolac-treated patients ( 81 % ) than naproxen-treated patients ( 53 % ) showed overall improvement at Day 2 , and etodolac was significantly better than naproxen on the Day 2 evaluation of joint swelling and at the Day 4 evaluations of joint tenderness , range of motion and the physician 's global assessment . At the final evaluation on Day 7 , 97 % of the etodolac group reported that their condition had improved as compared to 93 % of the naproxen group . Both drugs were well tolerated and only a few mild side-effects were reported A double-blind study was carried out to compare the effects of ketoprofen and phenylbutazone in acute gouty arthritis . Two groups of patients , each consisting of 23 males , received intramuscular injections of either phenylbutazone ( 2 X 300 mg daily ) or ketoprofen ( 2 X 50 mg daily ) for a period of 7 days . The drug effects were assessed both subjectively and objective ly . There was an excellent therapeutic effect in both groups . In general , no statistically-significant differences were detected between the two preparations . However , ketoprofen appears to be slightly better tolerated with respect to the incidence of systemic and local side effects . Thus , the administration of ketoprofen can be recommended in cases of acute gouty arthritis Introduction In phase-3 clinical trials , the interleukin ( IL-1 ) blocker , rilonacept ( IL-1 Trap ) , demonstrated efficacy for gout flare prevention during initiation of urate-lowering therapy . This trial evaluated rilonacept added to a st and ard-of-care , indomethacin , for treatment of acute gout flares . Methods Adults , aged 18 - 70 years , with gout presenting within 48 hours of flare onset and having at least moderate pain as well as swelling and tenderness in the index joint were r and omized to subcutaneous ( SC  ) rilonacept 320 mg at baseline plus oral indomethacin 50 mg TID for 3 days followed by 25 mg TID for up to 9 days ( n = 74 ) ; SC placebo at baseline plus oral indomethacin as above ( n = 76 ) ; or SC rilonacept 320 mg at baseline plus oral placebo ( n = 75 ) . The primary efficacy endpoint was change in pain in the index joint ( patient-reported using a Likert scale ( 0 = none ; 4 = extreme ) ) from baseline to the average of values at 24 , 48 and 72 hours ( composite time point ) for rilonacept plus indomethacin versus indomethacin alone . Comparison of rilonacept monotherapy with indomethacin monotherapy was dependent on demonstration of significance for the primary endpoint . Safety evaluation included clinical laboratory and adverse event ( AE ) assessment s. Results Patient characteristics were comparable among the groups ; the population was predominantly male ( 94.1 % ) , white ( 75.7 % ) , with mean ± SD age of 50.3 ± 10.6 years . All treatment groups reported within-group pain reductions from baseline ( P < 0.0001 ) . Although primary endpoint pain reduction was greater with rilonacept plus indomethacin ( -1.55 ± 0.92 ) relative to indomethacin alone ( -1.40 ± 0.96 ) , the difference was not statistically significant ( P = 0.33 ) , so formal comparison between monotherapy groups was not performed . Pain reduction over the 72-hour period with rilonacept alone ( -0.69 ± 0.97 ) was less than that in the other groups , but pain reduction was similar among groups at 72 hours . Treatment with rilonacept was well-tolerated with no reported serious AEs related to rilonacept . Across all groups , the most frequent AEs were headache and dizziness . Conclusions Although generally well-tolerated , rilonacept in combination with indomethacin and rilonacept alone did not provide additional pain relief over 72 hours relative to indomethacin alone in patients with acute gout flare . Trial registration Clinical Trials.gov registration number NCT00855920 A double-blind trial was carried out in 24 patients with acute gout to compare the efficacy and tolerance of feprazone , a non-steroidal anti-inflammatory drug , with that of phenylbutazone . Patients received 800 mg of either drug daily for 2 days and then 600 mg daily for up to 8 days . The results of patient assessment showed there was no significant difference between the two groups in time taken either to significant improvement or to final resolution of the gout attack . No side-effects were reported with either drug ABSTRACT Background and objective : Disease history and clinical features can influence treatment response in patients with acute gout . The purpose of this pooled subgroup analysis was to assess the association of baseline disease and patient characteristics with response to treatment in acute gout using data from two identical studies . Methods : Patients ≥ 18 years of age with onset of acute gout within 48 h associated with moderate , severe , or extreme pain involving less than four joints were eligible for inclusion in the primary studies , and were r and omized to etoricoxib 120 mg once daily ( N = 178 ) or indomethacin 50 mg three times daily ( N = 161 ) . The primary and secondary efficacy endpoints were analyzed using an analysis of covariance model to detect potential differential treatment responses across several subgroups : joint involvement ( mono-articular vs. oligo-articular ) , baseline pain severity ( moderate vs. severe ) , concomitant allopurinol and /or colchicine use ( users vs. nonusers ) , age ( < 45 , 45–55 , and > 55 years ) , gender , and race ( white or other ) . Results : Overall , etoricoxib and indomethacin demonstrated comparable efficacy across all subgroups . Compared with patients with oligo-articular disease , those with mono-articular disease had significantly greater improvements in patient assessment of pain , patient global assessment of response to therapy ( PGART ) , investigator global assessment of response to therapy ( IGART ) , and study joint tenderness ( p < 0.001 for all ) . Greater improvements were seen in patient assessment of pain ( p < 0.001 ) and study joint tenderness ( p < 0.05 ) for severe/extreme baseline pain compared with moderate baseline pain . Concomitant use of colchicine and /or allopurinol was associated with significantly worse IGART ( p < 0.05 ) . Conclusions : This pooled subgroup analysis demonstrated significantly greater response of acute gout to either etoricoxib or indomethacin among those with monoarticular disease , severe/extreme baseline pain , and non-use of colchicine and /or allopurinol . These results should be interpreted in the context of a pooled subgroup analysis with a limited sample size , and with the underst and ing that associations identified in such analyses do not define causation . Despite limitations , the results provide insights into the types of patients more likely to respond better to anti-inflammatory medication , and reiterate the importance of earlier effective control of the disease Objective . To evaluate the analgesic efficacy of high-dose celecoxib in the treatment of moderate to extreme pain and inflammation associated with acute gouty arthritis . Methods . A multinational , r and omized , double-blind , double-dummy , active-controlled trial was done with patients ( aged ≥ 18 years ) with acute gouty monoarthritis or oligoarthritis ( onset of pain ≤ 48 h before enrollment ) . Patients were treated for 8 days with 1 week followup and were r and omized 1:1:1:1 to receive celecoxib 50 mg bid , celecoxib 400 mg ( followed by 200 mg later on Day 1 and then 200 mg bid for 7 days ) , celecoxib 800 mg ( followed by 400 mg later on Day 1 and then 400 mg bid for 7 days ) , or indomethacin 50 mg tid . Results . Of 443 patients screened , 402 were r and omized and 400 received treatment . Baseline demographics were comparable among treatments . Patients receiving high-dose celecoxib ( 800/400 mg ) experienced a significantly greater reduction in pain intensity on Day 2 compared with low-dose celecoxib 50 mg bid [ least squares ( LS ) mean difference −0.46 ; p = 0.0014 ] . For high-dose celecoxib 800/400 mg , the change in pain scores from baseline to Day 2 was comparable with indomethacin 50 mg tid ( LS mean difference 0.11 ; p = 0.4331 ) . There were significant differences in adverse events when the combined celecoxib groups ( 29.5 % ) were compared with patients taking indomethacin ( 43.1 % ; p = 0.0116 ) . There was no change in median serum creatinine levels for any treatment . There were more discontinuations due to adverse events ( 8.8 % vs 3 % ; p = 0.0147 )  with  indomethacin than with the combined celecoxib groups . Conclusion . High-dose celecoxib ( 800/400 mg ) was significantly more effective than low-dose celecoxib ( 50 mg bid ) and comparable to indomethacin in the treatment of moderate to extreme pain in patients with acute gouty arthritis . Further , celecoxib was well tolerated Eighteen patients ( 11 men and 7 women ) suffering from primary or secondary gout , were treated with either proquazone or indomethacin for acute attacks in a double-blind study . There were 9 patients in each treatment group . A marked improvement of clinical symptoms appeared in 2 - 3 days . In the proquazone group , complete remission was achieved in 6 patients , a good result in one , and a slight improvement in one patient , whereas one patient did not respond to treatment . The corresponding figures for the indomethacin group were 4 cases with complete remission , 4 with a good result , and one not responding to treatment . A significant decrease in s-uric acid values was noted in the proquazone group . In this group too , mild gastrointestinal symptoms appeared in 2 patients Study objective We compare the analgesic efficacy and adverse effects of oral prednisolone/acetaminophen and oral indomethacin/acetaminophen combination therapy in the treatment of acute goutlike arthritis in patients presenting to an emergency department ( ED ) . Methods This is a double-blind , r and omized , controlled study in a university hospital emergency department ( ED ) in the New Territories of Hong Kong . Patients older than 17 years and presenting between February 1 , 2003 , and June 30 , 2004 , with a clinical diagnosis of goutlike arthritis were r and omized to receive either oral prednisolone/acetaminophen or oral indomethacin/acetaminophen combination therapy . Primary outcome measures were pain scores , time to resolution of symptoms and signs , and adverse effects . Secondary outcome measures were the need for additional acetaminophen and relapse rate . Results There were 90 patients r and omized : 46 patients to the indomethacin group and 44 patients to the prednisolone group . Baseline characteristics , including pain scores , were similar in the 2 groups . Both treatment groups had a similar decrease in pain score in the ED . The mean rate of decrease in pain score with activity for indomethacin was −1.7±1.6 ( SD ) mm per day and for prednisolone was −2.9±2.0 ( SD ) mm per day ( mean difference 1.2 mm/day ; 95 % confidence interval 0.4 to 2.0 mm 
    Output:
    
Moderate- quality evidence based upon four trials ( 974 participants ) indicated that NSAIDs and COXIBs produced similar benefits in terms of pain , swelling and global improvement , but COXIBs were associated with fewer adverse events .
The trials did not measure participant-reported global assessment and health-related quality of life .
Limited evidence supported the use of NSAIDs in the treatment of acute gout .
While these data were insufficient to draw firm conclusions , they did not conflict with clinical guideline recommendations based upon evidence from observational studies , other inflammatory arthritis and expert consensus , which support the use of NSAIDs in acute gout .
Moderate- quality evidence suggested that selective COX-2 inhibitors and non-selective NSAIDs are probably equally beneficial although COX-2 inhibitors are likely to be associated with significantly fewer total and gastrointestinal adverse events .
Moderate- quality evidence indicated that systemic glucocorticoids and NSAIDs were also equally beneficial in terms of pain relief .
There were no withdrawals due to adverse events and total adverse events were similar between groups .
There was low- quality evidence that there was no difference in function .