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Colchicine for Prophylaxis of Acute Flares When Initiating Allopurinol for Chronic Gouty Arthritis
GREGORY C. BORSTAD, LESLIE R. BRYANT, MICHAEL P. ABEL, DAREN A. SCROGGIE, MARK D. HARRIS, and JEFF A. ALLOWAY
ABSTRACT. Methods. Patients starting allopurinol for crystal-proven chronic gouty arthritis were randomized to receive colchicine 0.6 mg po bid or placebo in a randomized, prospective, double blind, placebo controlled trial. Subjects were followed for evidence of acute gout flares and remained on study drug for 3 months beyond attaining a serum urate concentration < 6.5 mg/dl. Treatment arms were analyzed regarding frequency of flares, likelihood of any flare or multiple flares, severity of flares on the visual analog scale (VAS), and length of flares in days. Results. Forty-three subjects were studied. Subjects treated with colchicine experienced fewer total flares (0.52 vs 2.91, p = 0.008), fewer flares from 0 to 3 months (0.57 vs 1.91, p = 0.022), fewer flares 3–6 months (0 vs 1.05, p = 0.033), less severe flares as reported on VAS (3.64 vs 5.08, p = 0.018), and fewer recurrent gout flares (p = 0.001). Colchicine was well tolerated. Conclusion. Colchicine prophylaxis during initiation of allopurinol for chronic gouty arthritis reduces the frequency and severity of acute flares, and reduces the likelihood of recurrent flares. Treating patients with colchicine during initiation of allopurinol therapy for 6 months is supported by our data. (J Rheumatol 2004;31:2429-32) Key Indexing Terms:
COLCHICINE From the Department of Rheumatology, Wilford Hall US Air Force Medical Center, Lackland AFB, San Antonio, Texas, USA. The work reported herein was performed under United States Air Force Surgeon General-approved Clinical Investigation No. FWH19970125H; WHMC Human Research. G.C. Borstad, MD, Assistant Professor of Medicine; L.R. Bryant, MD, Assistant Professor of Medicine; D.A. Scroggie, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland; M.P. Abel, MD; M.D. Harris, MD; J.A. Alloway, MD, Department of Rheumatology, Wilford Hall USAF Medical Center. Address reprint requests to Dr. G.C. Borstad, MAJ, USAF, MC, 60MDOS/SGOMJ, 101 Bodin Circle, Travis AFB, CA 94535, USA. Submitted March 25, 2004; revision accepted July 20, 2004. |