 2. The current referring physician judgment is that NSAIDs are not appropriate for treating the patients gouty arthritis flare which may be due to changes in patient status such as worsening co-morbid conditions or co-medications e.g., GI tract disease, renal insufficiency, hypertension, fluid retention, concurrent use of diuretics andor an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, especially in CKD 