Colchicine ineffective in hand OA: Australian study

Dr Courtney Davis

Colchicine is not effective in relieving the symptoms of hand osteoarthritis, an Australian randomised controlled trial has shown.

While the anti-inflammatory gout drug has previously shown some positive results in knee OA, a South Australian study involving 64 patients found that it was no better than placebo against pain or functional outcomes.

In a 12 week study, adults aged 40-80 with hand OA who were randomised to receive colchicine (0.5mg twice daily) showed no difference in the primary outcome measure was VAS hand pain score (0-100mm) compared to those who received placebo.

There was some improvement in both active and placebo groups over 12 weeks, with colchicine patients reducing from 61 to 53mm on the VAS Pain score compared to a decline from 64 to 46mm for placebo (between group difference 7.6mm p=0.18).

There were no differences in secondary outcomes such as tender and swollen joint count, grip strength, C-reactive protein, and Michigan Hand Questionnaire total, function and pain scores, according to findings published in Osteoarthritis and Cartilage.

Adverse reactions – predominantly gastrointestinal – occurred in nine of the 32 patients receiving colchicine, with four withdrawing from treatment because of adverse reactions.

The study investigators, led by Dr Courtney Davis (PhD) of the University of Adelaide, said the results contrasted with previous positive findings in knee OA seen in some small studies, although the largest study had shown no benefit for colchicine in knee OA.

They said it was possible colchicine might be effective via an anti-inflammatory effect in subgroups of patients with synovitis, but an exploratory analysis of ultrasound synovitis did not show between-group differences.

Likewise it was possible that colchicine may have an effect by reducing accumulation of inorganic crystals within the synovial fluid in patients with  OA, but the small trial did not recruit patients specifically with presence of crystals.

“Our results do not support the use of colchicine in hand osteoarthritis,” they concluded.

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