From the Guidelines
Yes, you can treat gout with both colchicine and prednisone, either separately or in combination depending on the severity of your gout attack. According to the American College of Physicians guideline from 2017 1, colchicine is typically used at a dose of 1.2 mg followed by 0.6 mg one hour later for acute attacks, with a maximum daily dose of 1.8 mg. For prednisone, a common regimen is 30-40 mg daily for 3-5 days, followed by a gradual taper over 1-2 weeks. These medications work differently: colchicine reduces inflammation by preventing neutrophils from moving to the affected joint, while prednisone is a corticosteroid that broadly suppresses inflammation.
Key Considerations
- Combination therapy may be more effective for severe attacks but also increases the risk of side effects.
- Common side effects of colchicine include diarrhea, nausea, and vomiting, while prednisone can cause increased blood sugar, fluid retention, and mood changes.
- It's essential to consult with your healthcare provider before starting these medications, especially if you have kidney or liver problems, as dosage adjustments may be necessary.
- During treatment, drink plenty of water, avoid alcohol, and limit high-purine foods to help manage your gout.
Treatment Recommendations
- The American College of Physicians recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout 1.
- Low-dose colchicine is recommended when using colchicine to treat acute gout, as it is associated with fewer gastrointestinal adverse effects 1.
- Corticosteroids, such as prednisone, are a viable option for treating acute gout, especially in patients without contraindications, as they are generally safer and a low-cost treatment option 1.
From the Research
Treatment of Gout with Colchicine and Prednisone
- Colchicine and prednisolone are two effective therapies for the treatment of acute gout, as stated in the study 2.
- A study comparing colchicine to placebo for the treatment of acute gout found that colchicine is an effective treatment for the reduction of pain and clinical symptoms in patients experiencing acute attacks of gout 3.
- The use of low-dose colchicine (1.8 mg over 1 hour) is effective in reducing pain and is well tolerated in patients with acute gout, as reported in the study 4.
- Prednisolone and colchicine are being compared in a pragmatic, prospective, double-blind, double-dummy, parallel-group, randomized, non-inferiority trial to investigate whether prednisolone is non-inferior to treatment with colchicine in patients with acute gout 5.
Efficacy and Safety of Colchicine
- Colchicine is a drug with a narrow therapeutic-toxicity window and with an important variability in tolerance between subjects, as discussed in the study 4.
- High-dose colchicine is associated with a greater number of adverse events, such as diarrhea, vomiting, or nausea, compared to low-dose colchicine or placebo, as reported in the study 6.
- Low-dose colchicine may be the preferred treatment option due to its effectiveness and lower risk of adverse events compared to high-dose colchicine, as suggested in the study 6.
Comparison of Colchicine and Prednisone
- There is limited evidence comparing the efficacy of colchicine to that of NSAIDs or corticosteroids, such as prednisolone, for the treatment of acute gout, as stated in the study 3.
- A study is currently investigating whether prednisolone is non-inferior to treatment with colchicine in patients with acute gout, with results expected to provide evidence on the effectiveness of pain reduction and side effects of colchicine and prednisolone in acute gout 2, 5.