Colchicine for acute gout

Schlesinger N, Schumacher R, Catton M, Maxwell L

Summary

Colchicine for acute gout

This summary of a Cochrane review presents what we know from research about the effect of colchicine for gout. The review shows that:

There is silver level evidence (www.cochranemsk.org) that to treat gout, 1 mg of colchicine followed by 0.5 mg every two hours taken within 12 to 24 hours of an attack may decrease pain, swelling, redness and tenderness. Colchicine may cause side effects such as nausea, vomiting and diarrhea.

It is not known whether colchicine is better than other treatments for gout.

What is gout and how can it be treated?
Gout is a type of arthritis in which there is a build up of crystals from uric acid in the joints of the body. In gout, the body either makes too much uric acid or it is not able to flush out excess uric acid from the body fast enough. When it builds up, the uric acid forms into crystals and can deposit in joints (especially in the big toe). In the joint, the deposits can cause pain, swelling and tenderness. An attack of gout may occur suddenly and go away on its own after 7 to 10 days or the pain and swelling can come on slowly and last for long periods. Non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin or naproxen, are often used first to decrease the pain and swelling. In people who cannot take NSAIDs because of side effects or when NSAIDs are not working, there are other treatments such as corticosteroids or colchicine. Colchicine, however, may cause stomach problems.

What are the results of this review?
People took either colchicine pills or a placebo (fake pill) for an attack of gout. When the attack began, people took 1 mg of colchicine and then 0.5 mg every 2 hours until the attack stopped or people felt too ill to continue taking colchicine.

Benefits of colchicine
In people who had an attack,

colchicine may improve pain more than placebo

* pain may improve by 34 more points on a scale of 0 to 100 with colchicine

colchicine may improve the symptoms of gout overall (such as pain, swelling, redness and tenderness) more than placebo

* symptoms may improve by 3.6 more points on a scale of 0 to 12 with colchicine

colchicine may improve the symptoms of gout faster

There were no studies that compared colchicine to other treatments for gout.

Harms of colchicine
In people who had an attack, colchicine may cause nausea, diarrhea or vomiting more than placebo
* 0 out of 100 people had diarrhea or vomiting with placebo (but 24 had nausea)
* 100 out of 100 people had diarrhea or vomiting with colchicine