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HWN Suggests

Gout: The Rich Man's Plague

Of the three major therapies (NSAIDs, glucocorticoids, and colchicine), there is no single best agent.

The best method is to review the patient’s comorbidities to each medication, their preference (if this is not their first flare), and how adequate is their rheumatology follow up. For example, if any renal disease is present, you must avoid NSAIDs. Other conditions in which we avoid NSAIDs: known coronary artery disease, peptic ulcer disease, certain anticoagulation medications, or poorly controlled diabetes mellitus.

Details of dosing

NSAIDs: naproxen, indomethacin, ibuprofen for 5-7 days

• perfect…

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 You Sure You Want Colchicine for Gout?

Colchicine has a high rate of adverse events, in particular explosive diarrhea, The drug also has a very narrow therapeutic index ...

Resources

Colchicine for acute gout: updated information about dosing and drug interactions

Recent trial evidence demonstrates that low-dose colchicine (2 tablets followed by 1 tablet 1 hour later) is effective when prescribed within 12 hours of onset of an acute gout flare, with a low incidence of gastrointestinal adverse effects

Colchicine for Gout Gets a Clean Bill of Health

Colchicine, a first-line treatment option for acute gout, is associated with an increased risk of adverse events, such as diarrhea and other gastrointestinal symptoms, but not serious adverse events, finds a newly published systematic review and meta-analysis.

Colchicine poisoning: the dark side of an ancient drug

Colchicine is used mainly for the treatment and prevention of gout and for familial Mediterranean fever (FMF). It has a narrow therapeutic index, with no clear-cut distinction between nontoxic, toxic, and lethal doses, causing substantial confusion among clinicians. Although colchicine poisoning is sometimes intentional, unintentional toxicity is common and often associated with a poor outcome.

Colchicine toxicity

Colchicine toxicity is rare but any intention overdose with colchicine is potentially lethal. Although resuscitation is a priority as with all toxicities, colchicine requires urgent decontamination due to the limited therapies we have once toxic serum levels develop.

Colchicine: Our Deal with the Devil

Colchicine has been in use medicinally since the 1st century AD.​1​ In truth, it’s quite the miracle drug for many inflammatory ailments. It works wonders for gout, is approved for use in familial Mediterranean fever, and has been shown to be beneficial in other off label indications such as pericarditis.​2​ For the botanists, anthophiles, and general lovers-of-plants (I discourage you from looking up ‘plantophile’ in the urban dictionary. . .) the alkaloid colchicine is derived from beautiful plants. Due to rapid cell turnover in the gut, GI symptoms herald the onset. In fact, diarrhea or vomiting is the most common side effect of therapeutic colchicine use. In overdose, GI losses start within several hours and can lead to severe volume depletion over the first 12-24 hours.

Fewer Side Effects With Naproxen vs Low-Dose Colchicine in Gout Flare Treatment

Compared with low-dose colchicine, naproxen therapy for gout flares was associated with fewer side effects, less analgesic use, and slightly lower costs, according to research results published in the Annals of the Rheumatic Diseases.