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Urate-lowering therapy with allopurinol sometimes precipitates acute gout flares. Guidelines thus recommend several months of anti-inflammatory prophylaxis (e.g., with colchicine) after starting allopurinol (NEJM JW Gen Med Jul 1 2020 and Arthritis Rheumatol 2020; 72:879). This practice developed when clinicians tended to start allopurinol at relatively high doses, but guidelines now recommend starting at low doses and slowly titrating up. Could this “start-low, go-slow” strategy make colchicine prophylaxis unnecessary?
To find out, researchers randomized 200 patients with gout who were starting allopurinol to receive colchicine (0.5 mg daily) or placebo for 6 months. Patients with estimated glomerular filtration rate (eGFR) ≥60 mL/minute/1.…