From the Research
Colchicine is effective for treating pseudogout, as evidenced by a significant reduction in acute arthritis episodes in patients taking the medication. The most recent and highest quality study, a 2021 Cochrane Review 1, suggests that low-dose colchicine may be an effective treatment for acute gout, with low-quality evidence indicating that its benefits may be similar to NSAIDs. For acute pseudogout flares, colchicine is typically prescribed as 0.6 mg taken 2-3 times daily until symptoms improve, usually for 7-10 days. A loading dose of 1.2 mg followed by 0.6 mg an hour later may be used at the onset of an attack.
Key Points
- Colchicine works by inhibiting neutrophil migration and activity, thereby reducing the inflammatory response to calcium pyrophosphate crystals in the joints.
- It also disrupts microtubule assembly and decreases crystal deposition.
- Common side effects include gastrointestinal symptoms like diarrhea, nausea, and vomiting, so it should be used cautiously in patients with kidney or liver disease.
- Dose adjustments are necessary for patients with renal impairment.
- For patients who cannot tolerate colchicine, NSAIDs or corticosteroids are alternative treatment options for pseudogout.
Dosage and Administration
- For acute pseudogout flares: 0.6 mg taken 2-3 times daily until symptoms improve, usually for 7-10 days.
- For prevention in patients with recurrent attacks: a lower maintenance dose of 0.6 mg once or twice daily is often recommended.
Important Considerations
- Colchicine has a narrow therapeutic-toxicity window and important variability in tolerance between subjects, as noted in a 2010 expert opinion article 2.
- A 1986 study 3 demonstrated the effectiveness of oral colchicine as a prophylactic agent in recurring pseudogout, with 90% of patients benefiting from the drug.