The patient has a history of gout, or there are intracellular negatively birefringent crystals in the joint.
Are NSAIDs contraindicated?
“There are patients for whom NSAID use is contraindicated, particularly those with true allergy, gastritis, peptic ulcer disease, renal insufficiency, and labile hypertension. … An alternative for gastrointestinal toxicity is to co-administer a proton pump inhibitor, second generation antihistamine, or misoprostol.”
NSAIDs Not Contraindicated