What is the evidence for colchicine (Nonsteroidal Anti-Inflammatory Drug) in treating osteoarthritis?

Colchicine for Osteoarthritis: Evidence Assessment

Colchicine is conditionally recommended against in patients with knee, hip, and/or hand osteoarthritis due to low-quality evidence of benefit and potential adverse effects. 1, 2

Evidence Summary

The 2020 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis clearly states that colchicine is conditionally recommended against in patients with knee, hip, and/or hand OA 1. This recommendation is based on the following considerations:

• Only two very small studies have suggested analgesic benefit of colchicine in OA, but the quality of the data was low
• Potential adverse effects and drug interactions are significant concerns

Recent Research Evidence

A 2023 systematic review and meta-analysis of intervention trials evaluating colchicine for OA found:

• No clinically important pain reduction with colchicine compared to control (moderate-quality evidence)
• No improvement in function with colchicine compared to control in knee OA patients (moderate-quality evidence) 3

The most recent high-quality evidence from a 2023 double-blind, randomized, placebo-controlled trial of colchicine for hand osteoarthritis (COLOR trial) showed:

• No difference between colchicine and placebo in pain reduction after 12 weeks
• More adverse events in the colchicine group (76 adverse events in 72% of participants) compared to placebo (42 adverse events in 44% of participants) 4

Similarly, a 2022 study comparing colchicine to physical therapy in knee osteoarthritis found that physical therapy demonstrated statistically significant improvements in pain scores and function compared to colchicine 5.

Clinical Considerations

Potential Adverse Effects

Colchicine use is associated with several adverse effects:

• Gastrointestinal side effects (diarrhea, nausea, vomiting)
• Drug interactions with multiple medications
• Risk of toxicity, particularly in patients with renal impairment 2

Special Populations

The risk of adverse effects is particularly concerning in older adults who:

• Often have chronic renal impairment
• May be taking multiple medications that could interact with colchicine
• Are more susceptible to colchicine toxicity 1

Clinical Context

While colchicine has established efficacy for conditions like gout and calcium pyrophosphate deposition disease (CPPD) 6, the evidence does not support its use for osteoarthritis. The European League Against Rheumatism (EULAR) recommendations support colchicine use for CPPD with acute attacks 1, but this should not be extrapolated to osteoarthritis treatment.

Treatment Algorithm for Osteoarthritis

Given the evidence against colchicine for OA, clinicians should follow the ACR/AF guideline recommendations for OA management, which include:

1. First-line approaches:

   • Topical NSAIDs for hand and knee OA
   • Oral NSAIDs (with gastroprotection if indicated)
   • Exercise and weight management

2. Second-line approaches:

   • Intra-articular corticosteroid injections
   • Duloxetine for knee and hip OA

3. Conditional recommendations for:

   • Tramadol (when other options have failed)

Colchicine should not be used for osteoarthritis management based on current evidence showing lack of efficacy and potential for harm.