Diclofenac is one of many choices that gout sufferers have for pain relief. So how do you and your doctor choose what's best for you? Here are some brief summaries of investigations into diclofenac for gout.
Diclofenac for Gout Research Topics
Does Voltaren Work for Gout?
In my first study, researchers aimed to gain better understanding of the gout patient's perspective. By studying personal experiences. As such, it highlights 2 specific issues concerning diclofenac for gout.
Te Karu, L., Bryant, L. and Elley, C.R., 2013. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study. Journal of Primary Health Care, 5(3), pp.214-222.
Issue #1 is using diclofenac as the only gout medication. Rather than as a support at the start of uric acid treatment.
Most had spent many years receiving symptomatic relief only.
Yeah well I had the Voltaren, oh [expletive] for maybe 20 odd years. But I used to take a lot of colchicine and stuff like that before allopurinol. Colchicine and something else… indomethacin, diclofenac [for 30 years] before allopurinol four months ago.
Issue #2 is lack of patient knowledge about drug names. Leading to duplicate dosing of diclofenac with Voltaren.
Some participants discussed adverse effects from non-steroidal anti-inflammatory medications (NSAIDs).
I got upset puku (stomach) and diarrhoea and an ulcer too. It was from taking the aspirin and the diclofenac and the Voltaren. [This participant was co-administering Voltaren and diclofenac thinking they were different medicines].
Diclofenac Pills or Steroid Shots for Gout?
Researchers in my second study acknowledge that NSAIDs carry risks of stomach and heart problems. So they investigated the effectiveness and adverse events (AEs). Comparing diclofenac as an NSAID example, with a corticosteroid, betamethasone (diprospan). Finding that, over a 7-day period, a single steroid shot was more effective than daily diclofenac pills.
Zhang, Y.K., Yang, H., Zhang, J.Y., Song, L.J. and Fan, Y.C., 2014. Comparison of intramuscular compound betamethasone and oral diclofenac sodium in the treatment of acute attacks of gout. International journal of clinical practice, 68(5), pp.633-638.
In conclusion, this study showed that compound betamethasone 7 mg i.m. once for all was more effective and had quicker effects than diclofenac sodium 75 mg oral administration twice a day for 7 days for acute attack of gout within 24 h. Two therapeutic regimens had comparable efficacy on Day 7. Compound betamethasone had better tolerance and fewer AEs compared with diclofenac sodium.
Diclofenac or Etoricoxib for Gout?
My third study is a review of investigations into etoricoxib. In order to assess its safety and effectiveness as a pain treatment for gout. Finding that etoricoxib is as effective as diclofenac, and has fewer side effects.
Zhang, S., Zhang, Y., Liu, P., Zhang, W., Ma, J.L. and Wang, J., 2016. Efficacy and safety of etoricoxib compared with NSAIDs in acute gout: a systematic review and a meta-analysis. Clinical rheumatology, 35(1), pp.151-158.
Compared with indometacin and diclofenac, etoricoxib had a lower incidence of adverse events. Etoricoxib 120 mg administered orally once daily has the same efficacy on acute gout as indometacin and diclofenac. Etoricoxib is tolerated better by patients than NSAIDs such as indometacin and diclofenac.
Stomach Bleeding and Diclofenac
NSAIDs are associated with Upper Gastrointestinal Bleeding (UGIB). So researchers in my fourth study investigated diclofenac. As a common NSAID for gout. With a view to assessing risk factors.
They found that diclofenac (compared with no diclofenac) is associated with 5.29 times the risk of gastrointestinal bleeding. Therefore, recommending diclofenac should be taken for gout flares for the shortest time possible.
Ghazali, W.S.W., Zainudin, W.M.K.B.W., Yahya, N.K., Ismail, A.M. and Wong, K.K., 2021. Older age and diclofenac are associated with increased risk of upper gastrointestinal bleeding in gout patients. PeerJ, 9, p.e11468.
In conclusion, older age and diclofenac prescription were significant risk factors for UGIB development in gouty arthritis patients on NSAIDs. Thus, patients presented with these risk factors should be routinely monitored to prevent the occurrence of UGIB. We also recommend that diclofenac be prescribed for the shortest duration possible to manage gout flares.
Diclofenac and Quercetin
In my final study, researchers seek to measure the effects of quercetin on the perception of pain blocking from diclofenac for gout. Using induced gout pain in rats. They found that quercetin (QUER) reduces the effectiveness of diclofenac (DIC).
Ventura-Martínez, R., Déciga-Campos, M., Bustamante-Marquina, A., Ángeles-López, G.E., Aviles-Herrera, J., González-Trujano, M.E. and Navarrete-Vázquez, G., 2021. Quercetin decreases the antinociceptive effect of diclofenac in an arthritic gout-pain model in rats. Journal of Pharmacy and Pharmacology, 73(10), pp.1310-1318.
All these data demonstrated that the simultaneous administration of QUER + DIC produces an unfavorable interaction on the antinociceptive effect of DIC. Therefore, this combination might not be recommendable to relieve arthritic gout-pain.
Your Diclofenac for Gout Research Story
Which aspects of diclofenac for gout are you interested in? Do you take diclofenac to control your gout pain? Or do you prefer a different anti-inflammatory for gout?
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