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Colchicine for acute gout

  • Review
  • Intervention

Authors


Abstract

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.

摘要

背景

秋水仙素治療急性痛風

痛風是常見風濕病之一,秋水仙素治療急性痛風被認為有效,但腸胃副作用高。

目標

研究秋水仙素治療急性痛風比上安慰劑或另一種治療的效果及安全性。

搜尋策略

搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2006), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (fro 982), AMED (from 1985), Web of Science (from 1945) and Current Controlled Trials到2006年3月。同時手動搜尋專業雜誌及所選回顧文章之參考文獻。

選擇標準

選入隨機對照試驗或對照控制試驗秋水仙素治療急性痛風的效果及副作用研究。

資料收集與分析

兩位作者進行資料摘錄,並對每篇試驗研究的品質已經過效度評估之工具進行評估。連續性資料使用加權平均差異分析,二分法類別資料使用相對風險(RR)來分析。有顯著差異之結果,計算益一治療數(NNT)。

主要結論

1個隨機對照試驗研究秋水仙素比上安慰劑﹝43位患者﹞治療急性痛風,結果秋水仙素比安慰劑減少疼痛絕對值34% ,減少壓痛、紅、腫症狀30% 。減少疼痛NNT為3,減少症狀NNT為2。所有使用秋水仙素者皆有胃腸副作用﹝拉或吐﹞,NNT為1。無比較秋水仙與非類固醇消炎止痛劑、類固醇或ACTH之研究。

作者結論

秋水仙素治療急性痛風對減少疼痛及症狀有效,但效益與毒性比低,限制其使用性。秋水仙素應作為非類固醇消炎止痛劑或類固醇無效或有使用禁忌時之第二線急性痛風治療藥物。需更多比較秋水仙素與非類固醇消炎止痛劑或類固醇治療急性痛風之研究。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

銀級證據顯示,秋水仙素1 mg然後12到24小時內每兩小時使用0.5 mg,減少疼痛及紅腫壓痛症狀。秋水仙素造成拉或吐之胃腸副作用,秋水仙是否比其他治療好,並不清楚。痛風是尿酸結晶堆積在關節引起的關節炎疾病,尿酸生產過剩或排泄不良會造成痛風,尿酸過高堆積在關節,尤其是大腳趾關節,造成紅腫熱痛,痛風通常突然發生,7到10天或更久後自然消退。非類固醇消炎止痛劑如indomethacin或naproxen通常為第一線治療,當非類固醇消炎止痛劑無效或有使用禁忌時,使用秋水仙素或類固醇。但秋水仙素造成胃腸副作用。急性痛風發作時,秋水仙素1 mg然後每兩小時使用0.5 mg,直到疼痛緩解或副作用發生,秋水仙素比安慰劑更能緩解疼痛34% 以上 −100 VAS),減少發炎症狀3.6點以上﹝0 – 12﹞及更快緩解症狀。無比較秋水仙與非類固醇消炎止痛劑或類固醇之研究。秋水仙素每100人中有100人會有拉或吐副作用,而安慰組中每100人中有0人有拉或吐﹝24人有噁心﹞。

Plain language summary

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

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