What is the role of colchicine in the treatment of Behcet's disease?

From the Guidelines

Colchicine is a first-line treatment for Behcet's disease, particularly effective for managing mucocutaneous manifestations such as oral and genital ulcers, erythema nodosum, and arthritis. The typical dosage is 0.5-1.2 mg daily, often started at 0.6 mg once or twice daily, with adjustments based on response and tolerability. According to the 2018 update of the EULAR recommendations for the management of Behcet's syndrome 1, colchicine should be tried first for the prevention of recurrent mucocutaneous lesions, especially when the dominant lesion is erythema nodosum or genital ulcer.

Key Points to Consider

• Colchicine works by inhibiting neutrophil chemotaxis, decreasing inflammatory cytokine production, and disrupting microtubule formation, thereby reducing the inflammatory response characteristic of Behcet's disease.
• Common side effects include gastrointestinal disturbances like diarrhea, nausea, and abdominal pain, which can be minimized by starting with lower doses and gradually increasing.
• Dose reduction is necessary for patients with renal or hepatic impairment, and colchicine should be used cautiously with certain medications like macrolide antibiotics and statins due to potential interactions.
• While colchicine is effective for milder manifestations, more severe organ involvement such as ocular, neurological, or vascular complications typically requires additional immunosuppressive therapies.

Treatment Approach

• Treatment is usually long-term, as Behcet's is a chronic condition requiring ongoing management.
• The decision to treat skin and mucosa involvement will depend on the perceived severity by the doctor and the patient, and mucocutaneous involvement should be treated according to the dominant or codominant lesions present 1.
• Topical measures such as steroids should be used for the treatment of oral and genital ulcers, and colchicine should be preferred when the dominant lesion is erythema nodosum.

From the Research

Role of Colchicine in Behcet's Disease

• Colchicine is used as a steroid-sparing agent and to prevent relapses in the treatment of Behcet's disease 2.
• It is also used to treat mucocutaneous lesions, which are a common manifestation of the disease 3.
• The effectiveness of colchicine in treating Behcet's disease has been studied, with some studies showing promising results 4.
• However, other studies have found that colchicine may not be as effective as other treatments, such as ciclosporin, in reducing oral lesions 5.

Treatment of Mucocutaneous Lesions

• Colchicine is one of several treatments that can be used to manage mucocutaneous lesions in Behcet's disease, including topical or intralesional corticosteroids, oral pentoxifylline, sucralfate, dapsone, and systemic low-dose corticosteroids 3.
• Azathioprine or methotrexate can be used if the lesions are refractory to these treatments, and tumor necrosis factor (TNF) inhibitors such as infliximab or etanercept can be considered if azathioprine or methotrexate fails 3.

Efficacy of Colchicine

• The efficacy of colchicine in treating recurrent oral ulcers, a common symptom of Behcet's disease, has been evaluated in several studies 5.
• While some studies have found colchicine to be effective in reducing pain and accelerating healing, others have found it to be less effective than other treatments 5.
• Further research is needed to fully understand the role of colchicine in the treatment of Behcet's disease and to determine its efficacy in different patient populations 5.