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Treating acute gout

Issue 30 Synovium (Summer 2010)

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The treatment of acute gout has always been something of a challenge with the potential for unpleasant side-effects, adverse drug interactions and exacerbation of comorbidities with conventional treatments (NSAIDs and high-dose colchicine). So here is some good news. A randomised, double-blind, placebo-controlled trial from California1 has demonstrated that administration of a low total dose of colchicine (1.8 mg) over 1 hour was as effective as conventional high total dose colchicine (4.8 mg) administered over 6 hours at reducing the pain of acute gout by at least 50%, and was associated with an adverse-effect profile little greater than placebo. In an intriguingly designed study, patients in all three groups were given a pack containing 8 tablets of identical appearance to treat an attack of acute gout. They were instructed to take the first two tablets together and then a further tablet each hour for 6 hours. The control group received 8 placebo tablets, the high-dose group 8 tablets containing 0.6 mg of colchicine, and the low-dose group 3 tablets containing 0.6 mg of colchicine and 5 placebo tablets. Of 575 patients entered into the study 185 had an acute attack of gout during the study period and took medication. Most subjects were overweight, middle-aged white males and had a diagnosis of gout for at least 10 years and a high serum urate. In the low-dose colchicine group 37.8% achieved a ≥50% reduction in pain within 24 hours of commencing medication. Corresponding figures for the high-dosage group were 32.7% and for the placebo group 15.5%. Reported adverse effects were chiefly gastrointestinal disturbance – nausea, vomiting, abdominal pain and diarrhoea – and occurred in 76.9% of patients taking high-dose colchicine, 36.5% of the low-dose group and 27.1% of the placebo group.

So low-dose colchicine would seem to be an excellent treatment for acute gout. Unfortunately the BNF only lists tablets of 0.5 mg of colchicine as being available to UK prescribers but perhaps this trial will prompt a change.

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