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In years past, patients with acute gout were treated with oral colchicine, given every 1 to 2 hours until pain subsided or intolerable gastrointestinal side effects occurred. Although this approach largely has been abandoned, a well-tolerated colchicine regimen would be a useful alternative for patients with contraindications to nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.
In an industry-sponsored randomized trial, 184 patients with acute gout flares received high-dose colchicine (1.2 mg initially, followed by 0.6 mg hourly for 6 hours), low-dose colchicine (1.2 mg initially, followed by 0.6 mg 1 hour later), or placebo. The primary endpoint — a reduction of ≥50% on a pain-score index at 24 hours — occurred in 38% of low…