In gouty arthritis

The efficacy and safety of cyclooxygenase-2 (COX-2) selective inhibitors (e.g., celecoxib) have not been fully assessed in gouty arthritis, but they are more costly than conventional NSAIDs and are unlikely to result in fewer GI complications because of the short duration of therapy. 

Tolmetin (Tolectin) is indicated for the relief of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and moderate pain. It is ineffective in gouty arthritis for unknown reasons. Tolmetin can inhibit both COX-1 and COX-2 but has a moderate selectivity for COX-1. The most frequently reported side effects are GI disturbance and CNS reactions (e.g., headache, asthenia, and dizziness). These effects are less frequently observed than after aspirin or indomethacin use. Blood pressure elevation, edema, and weight gain or loss have been associated with tolmetin administration. Tolmetin metabolites in urine have been found to produce pseudoproteinuria in some laboratory tests. 

In addition to the phagocytic activity of the leukocytes, small peptide substances, such as the kinins, which are thought to be partially responsible for the local inflammatory response in gouty arthritis, accumulate in the joint space. The inflammation is associated with local vasodilation, increased vascular permeability, and pain. 

Getting SJ et al Activation of melanocortin type 3 receptor as a molecular mechanism for adrenocorticotropic hormone efficacy in gouty arthritis. Arthritis Rheum 2002 46 2765. [PMID 12384937]... 

Medical pain in osteoarthritis, etoricoxib is given orally in a usual dose of 30 mg once daily, increased to 60 mg once daily if necessary. The recommended dose in rheumatoid arthritis and in ankylosing spondylitis is 90 mg once daily higher doses of 120 mg once daily are used in gouty arthritis although such doses should only be used for the acute symptomatic period and for a maximum of 8 days [4j. 

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