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Colchicine for acute gout

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Abstract

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Background

Gout is one of the most common rheumatic diseases worldwide. Colchicine is regarded as beneficial in the treatment of acute gout, but has a high frequency of gastrointestinal adverse events.

Objectives

To evaluate the efficacy and safety of colchicine for relief of the signs and symptoms of acute gouty arthritis, compared to placebo and other treatment interventions.

Search methods

We searched the following electronic databases to March 2006: Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2006), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1982), AMED (from 1985), Web of Science (from 1945) and Current Controlled Trials.

Selection criteria

Published randomised controlled trials (RCTs) and controlled clinical trials evaluating symptom relief and adverse outcomes of colchicine therapy in acute gout were considered for this review.

Data collection and analysis

Two reviewers independently screened search results for inclusion, collected the data in a standardized form and assessed the methodological quality of the trial using validated criteria. Results for continuous outcome measures were expressed as weighted mean differences. Dichotomous outcome measures were pooled using relative risk. The number needed to treat was calculated for significant outcomes.

Main results

One RCT (N=43) comparing colchicine to placebo for the treatment of acute gout was included in this review. The results favour the use of colchicine over placebo with an absolute reduction of 34% for pain and a 30% reduction in clinical symptoms such as tenderness on palpation, swelling, redness, and pain. The number needed to treat (NNT) with colchicine versus placebo to reduce pain was 3 and the NNT to reduce clinical symptoms was 2. All participants treated with colchicine experienced gastrointestinal side effects (diarrhea and/or vomiting) and the number needed to harm (NNH) with colchicine versus placebo was 1. No studies comparing colchicine to NSAIDs or other treatments such as corticosteroids or ACTH were identified.

Authors' conclusions

Colchicine is an effective treatment for the reduction of pain and clinical symptoms in patients experiencing acute attacks of gout, although in the regimen studied its low benefit to toxicity ratio limits its usefulness. It should be used as a second line therapy when NSAIDs or corticosteroids are contraindicated or ineffective. More evidence is needed to compare the efficacy of colchicine to that of NSAIDs or corticosteroids, the current first line therapy for acute gout.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Colchicine for acute gout

This summary of a Cochrane review presents what we know from research about the effect of colchicine for gout. The review shows that:

There is silver level evidence (www.cochranemsk.org) that to treat gout, 1 mg of colchicine followed by 0.5 mg every two hours taken within 12 to 24 hours of an attack may decrease pain, swelling, redness and tenderness. Colchicine may cause side effects such as nausea, vomiting and diarrhea.

It is not known whether colchicine is better than other treatments for gout.

What is gout and how can it be treated?
Gout is a type of arthritis in which there is a build up of crystals from uric acid in the joints of the body. In gout, the body either makes too much uric acid or it is not able to flush out excess uric acid from the body fast enough. When it builds up, the uric acid forms into crystals and can deposit in joints (especially in the big toe). In the joint, the deposits can cause pain, swelling and tenderness. An attack of gout may occur suddenly and go away on its own after 7 to 10 days or the pain and swelling can come on slowly and last for long periods. Non‐steroidal anti‐inflammatory drugs (NSAIDs), such as indomethacin or naproxen, are often used first to decrease the pain and swelling. In people who cannot take NSAIDs because of side effects or when NSAIDs are not working, there are other treatments such as corticosteroids or colchicine. Colchicine, however, may cause stomach problems.

What are the results of this review?
People took either colchicine pills or a placebo (fake pill) for an attack of gout. When the attack began, people took 1 mg of colchicine and then 0.5 mg every 2 hours until the attack stopped or people felt too ill to continue taking colchicine.

Benefits of colchicine
In people who had an attack,

colchicine may improve pain more than placebo

* pain may improve by 34 more points on a scale of 0 to 100 with colchicine

colchicine may improve the symptoms of gout overall (such as pain, swelling, redness and tenderness) more than placebo

* symptoms may improve by 3.6 more points on a scale of 0 to 12 with colchicine

colchicine may improve the symptoms of gout faster

There were no studies that compared colchicine to other treatments for gout.

Harms of colchicine
In people who had an attack, colchicine may cause nausea, diarrhea or vomiting more than placebo
* 0 out of 100 people had diarrhea or vomiting with placebo (but 24 had nausea)
* 100 out of 100 people had diarrhea or vomiting with colchicine