SLR - November 2014 - Elza Tyshko
Evaluating Appropriate Use of Prophylactic Colchicine for Gout Flare Prevention
Reference: Michael George, Sally Pullman-Mooar, Fauzia Hussain, and H. Ralph Schumacher. Evaluating Appropriate Use of Prophylactic Colchicine for Gout Flare Prevention. Arthritis Care and Research; 66(8): 1258-1262.
Scientific Literature Review
Reviewed By: Elza Tyshko, DPM
Residency Program: Albert Einstein Medical Center, Philadelphia, PA
Podiatric Relevance: Gout is a common disease in general podiatric practice, which is characterized by the deposition of sodium urate crystals in the joints, such as 1st MTPJ and ankle, causing acute inflammation of chronic arthritis. Colchicine is the medication that is most commonly prescribed to decrease these gout flares. This study concluded that there is a high prevalence of inappropriate prophylactic colchicine use. Appropriate colchicine use is important to avoid unnecessary medication exposure and its side effects, as well as the expensive cost of colchicine makes optimal use of it financially important.
Methods: Electronic medical records were reviewed for 126 patients prescribed with colchicine for the prophylaxis of gout flares. Colchicine use was considered inappropriate if 1) no urate-lowering therapy was prescribed, 2) uric acid was not at goal and urate-lowering therapy had not been increased in the prior three months, and 3) uric acid goals were met for >1 year without flares or tophi. PCP documentation of diagnosis of gout, medical and laboratory records, as well as review of medical visits was used in the study.
Results: Colchicine use was considered inappropriate in 93 patients (73.8 percent): 34 of them were prescribed no urate lowering therapy, 50 were above uric acid goal without urate lowering therapy increase in the prior three months, and nine were at the uric acid goal for over one year with flares resolved in the absence of tophi. Patient considered appropriately prescribed with colchicine were younger and more likely to have ever seen a rheumatologist. Uric acid levels, renal function, and allopurinol dose and allergy were similar in the two groups.
Conclusion: There is a high prevalence of inappropriate prophylactic colchicine use, mostly due to the failure or prescription of urate-lowering therapies or adequately increase these medications. Daily consumption of colchicine provides reduction in pain, however prescribing colchicine without urate-lowering therapy allows urate crystals to continue to form.