Can colchicine be taken for acute gouty arthritis?

From the Guidelines

Colchicine is a recommended treatment for acute gouty arthritis, with a strong recommendation to use low-dose colchicine, as it is as effective as higher doses in reducing pain and has fewer gastrointestinal adverse effects. The recommended dosing is typically 1.2 mg initially, followed by 0.6 mg one hour later, for a total of 1.8 mg on the first day, as supported by moderate-quality evidence from studies such as 1 and 1. After that, patients usually take 0.6 mg once or twice daily until the acute attack resolves. Treatment should begin as soon as possible after symptom onset for maximum effectiveness, ideally within the first 12-24 hours.

Some key points to consider when prescribing colchicine for acute gouty arthritis include:

• Common side effects include gastrointestinal symptoms like diarrhea, nausea, and vomiting, as reported in studies such as 1 and 1.
• Colchicine should be used with caution in patients with kidney or liver disease, and dose adjustments may be necessary, as noted in 1.
• The medication works by reducing inflammation by preventing neutrophils from migrating to the inflamed joint and inhibiting the formation of inflammatory mediators.
• It's essential to stay well-hydrated while taking colchicine and to avoid grapefruit juice, which can increase the risk of side effects, as mentioned in general medical knowledge.
• If gastrointestinal side effects occur, the medication should be temporarily stopped, as recommended in 1 and 1.

Overall, the use of low-dose colchicine for acute gouty arthritis is supported by moderate-quality evidence and is a recommended treatment option, as stated in 1 and 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1.1 Gout Flares Colchicine Tablets, USP are indicated for prophylaxis and the treatment of acute gout flares. Prophylaxis of Gout Flares: Colchicine Tablets, USP are indicated for prophylaxis of gout flares. Treatment of Gout Flares: Colchicine Tablets, USP are indicated for treatment of acute gout flares when taken at the first sign of a flare.

Yes, colchicine can be taken for acute gouty arthritis, as it is indicated for the treatment of acute gout flares when taken at the first sign of a flare 2.

From the Research

Efficacy of Colchicine for Acute Gouty Arthritis

• Colchicine is regarded as beneficial in the treatment of acute gout, with a study from 3 showing an absolute reduction of 34% for pain and a 30% reduction in clinical symptoms.
• A phase III trial mentioned in 4 found that the recommended dosage of colchicine was significantly more effective than placebo in treating acute gout flare, with a >50% reduction in pain within 24 hours of initiating treatment.
• The updated Cochrane Review from 5 suggests that low-dose colchicine may improve treatment outcome compared to placebo with little or no increased risk of adverse events.

Safety and Adverse Events

• Colchicine has a high frequency of gastrointestinal adverse events, with all participants in the study from 3 experiencing gastrointestinal side effects.
• The study from 4 found that the incidence of the most common adverse events was similar between recipients of the recommended dosage of colchicine and placebo.
• The review from 5 found that high-dose colchicine may increase the number of adverse events compared to placebo, while low-dose colchicine may have a similar number of adverse events to NSAIDs.

Comparison to Other Treatments

• The study from 3 did not identify any studies comparing colchicine to NSAIDs or other treatments such as corticosteroids.
• The review from 5 found low-quality evidence that low-dose colchicine may be an effective treatment for acute gout when compared to placebo and low-quality evidence that its benefits may be similar to NSAIDs.
• The study from 6 recommends that acute gouty arthritis should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents.
• The study from 7 suggests that intra-articular steroids, systemic steroids, NSAIDs, and colchicine are suitable for relieving acute arthritis urica.