Colchicine in acute gout

Editor – we read with interest Morris et al’s Lesson of the Week on
the use of colchicine in gout (Morris I, Varughese G, Mattingly P.
Colchicine in acute gout. BMJ 2003; 327: 1275 -6). We agree that the
guidelines in the British National Formulary (BNF) do not reflect
established practice amongst Rheumatologists. Indeed, local guidelines
that have existed in our own large District General Rheumatology Unit for
at least five years advocate the use of colchicine 0.5mg twice or three
times daily both for acute gout, and also long term when allopurinol
therapy is insufficient. An editorial in The Lancet as long ago as 1989
similarly recommended colchicine as a safe and effective prophylactic
(Anon. Polyarticular gout. The Lancet 1989 April 1; 1(8640): 703-4.)
However, although the BNF mentions its use in prophylaxis, the emphasis is
on short-term usage; it is unfortunately our experience that prescriptions
for long-term therapy are commonly questioned by Pharmacies, as this
regime deviates from BNF guidance. Thus patients are denied effective
treatment.

Further, an ageing population with significant comorbidities means
that an appreciable proportion of patients presenting with difficult gout
are those with severe cardiac failure and / or renal insufficiency who are
treated with low-dose aspirin and diuretics. Thus non-steroidal anti-
inflammatory drugs are contraindicated. Low-dose colchicine is a useful
and safe member of the therapeutic armamentarium.

Competing interests:
None declared