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Prophylactic Colchicine for Patients Starting Allopurinol

Colchicine prevented gout flares among arthritis patients in this small randomized trial.

Because interventions that lower uric acid levels can be associated with acute flares of gout, many clinicians prescribe prophylactic colchicine when they initiate allopurinol. These researchers from a rheumatology clinic addressed the effectiveness of that approach.

They studied 43 patients with gouty arthritis who were starting allopurinol treatment. The patients' mean baseline uric acid level was 9.3 mg/dL, and 63% had tophi. Allopurinol dosage usually was started at 100 mg daily and was titrated upward every few weeks until the uric acid level was <6.5 mg/dL.

Patients were randomized to receive colchicine (0.6 mg twice daily) or placebo. During 6 months of follow-up, at least one gout flare occurred in 33% of colchicine recipients and in 77% of placebo recipients -- a significant difference. Most flares occurred during the first 3 months. Flares were significantly milder with colchicine than with placebo.

Comment: This small study confirms the conventional wisdom about combining colchicine prophylaxis with initial allopurinol therapy. Both of these drugs should be used cautiously, however, in patients with renal impairment. Finally, the high prevalence of tophi among the subjects in this study suggests that these patients might not be representative of those encountered typically in primary care settings.

— Allan S. Brett, MD

Published in Journal Watch General Medicine January 21, 2005

Citation(s):

Borstad GC et al. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol 2004 Dec; 31:2429-32.

• Medline abstract (Free)