The presence of uric acid and/or calcium in osteoarthritic joints is not a general feature. It is true for gouty arthritis but not for other types of OA. Thus, colchicine is likely to be ineffective in most cases of knee OA. You may be interested in reading the "OARSI recommendations for the management of hip and knee osteoarthritis: Part III: changes in evidence following systematic cumulative update of research published through January 2009"

http://www.sciencedirect.com/science/article/pii/S1063458410000464

Colchicine may provide some relief from pain in OA due to its inherent anti-inflammatory effect. But since it is a potentially toxic drug, I never use this drug to treat osteoarthritis.

Ravi

It is tolerable when used at a low dose for gouty flare in patents with no contra indications.."Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. Apr 2010;62(4):1060-8. [Medline]."

Alexandrian:

However, "A double-blind randomized controlled trial appraising the symptom-modifying effects of colchicine on osteoarthritis of the knee." has compaling evidence that one cannot simply ignore and pain control was impressive in this group .

Clin Exp Rheumatol. 2011 May-Jun;29(3):513-8. Epub 2011 Jun 29.

A double-blind randomized controlled trial appraising the symptom-modifying effects of colchicine on osteoarthritis of the knee.

Aran S : Center for Advanced Orthopaedic Studies, harvard Medical School, Boston, MA 02215, USA. [email protected]

If the OA has an inflammatory component that could have a crystal component, more typically pyrophosphate, then colchicine may be helpful. However, in most cases of OA, colchicine would not be useful.

Primary OA is not responded with colchicine and antiinflamatory effect of it is seen only in gouty arthritits. I donot use it for OA.

Dear Kaz,

I think this is probably the wrong question to ask. Not many people believe OA is an inflammatory disease mediated by IL-1. It is a good idea for clinicians not to believe too much of the hype coming from labs wanting to get grant money in. OA is not in fact a disease. It is a collection of structural changes, most obviously fragmentation of cartilage, seen as result of almost any joint insult. I would not make a decision to use colchicine based on that diagnostic category - it is irrelevant. The interesting question would be whether colchicine is useful in knee pain associated with evidence of inflammation in patients without crystals. (In the cases with crystals then we already know colchicine can help.)

The study you quote is to my mind not convincing, at least on the basis of the abstract. Endpoints are not well described - just subjective 'global assessment' and it is unclear why there are two versions. If you take colchicine 0.5mg twice daily it is fairly obvious that you are taking it because your bowel habit is very likely to change. So we cannot take this to be a blinded trial. Trials with subjective endpoints that are not convincingly blinded are not really of much value. The findings may turn out to be repeatable but I think that needs to be seen.

Dear Jonathan. Point taken. Thank you

Dear Kaz,

I agree with Jonathan pertaining to the use of Colchicine in clinical settings without significant amount of data on the subject matter. However, I would like to add some points here. Please refer to the references quoted below when required:

(A) On a molecular level, IL-1 is definitely a marker of cartilage destruction but not the sole marker [1,2].

(B) Colchicine is known to have inhibitory effect on mitosis and hence cell division [3]. This may interfere with the proliferation capacity of the remaining chondrocytes. This in turn may result in further degradation of the cartilage tissue. Moreover, Colchicine has low therapeutic index and may also damages bone marrow [4, 5]. Now, if bone marrow is damaged, this may further worsen the condition by affecting the recruitment of stem cells from bone marrow that may repair the damaged tissue.

(C) I disagree with the point made by Jonathan about the status of you cited studies as not being double-blinded. Assuredly, both the researchers and the participants were blinded. It is very unlike that a patient would know the GIT problems associated with Colchicine. So, I think at least the approach quoted by the authors is not questionable here.

I hope it may help.

References:

[1] Joos, H et al. Interleukin-1 beta and tumor necrosis factor alpha inhibit migration activity of chondrogenic progenitor cells from non-fibrillated osteoarthritic cartilage. Arthritis Res Ther. 2013;15(5):R119.

[2] Park, SJ et al. MicroRNA-127-5p regulates matrix metalloproteinase 13 expression and interleukin-1β-induced catabolic effects in human chondrocytes. Arthritis Rheum. 2013 Dec;65(12):3141-52.

[3] Bhattacharyya, B et al. Anti-mitotic activity of colchicine and the structural basis for its interaction with tubulin. Med Res Rev. 2008 Jan;28(1):155-83.

[4] Nuki G. Colchicine: its mechanism of action and efficacy in crystal-induced inflammation. Curr Rheumatol Rep. 2008 Jul;10(3):218-27.

[5] Harris, R et al. Colchicine-induced bone marrow suppression: treatment with granulocyte colony-stimulating factor. J Emerg Med. 2000 May;18(4):435-40.

Dear Kaz

Calcium pyrophosphate deposition is a type of arthritis that, as the old name of pseudogout suggests, can cause symptoms similar to gout

People with poor kidney function, who have a history of stomach ulcers and/or who are on blood thinners often cannot take NSAIDs

For these patients, it may help to drain the joint fluid and inject a corticosteroid into the affected joint. To try to prevent further attacks, low doses of colchicine (a medicine used more often for gout) may prove effective.

Not unless the joint with OA also has evidence of CPPD and/or gout, as above-mentioned. The other clinical uses of colchicine other than crystal arthritis include familial mediterranean fever (FMF), and possibly painful oral ulcers from Behcet's disease. Colchicine has also been tried in other conditions such as pericarditis, and even chronic liver fibrotic diseases, in this this latter without much success.

Dear Fazal,

One day in the future, after forty years in joint histology, in developing drug assays, and in trials in collagenase inhibitors, cytokine inhibitors, imunomodulators and goodness knows what you may perhaps become as cautious as I have. Most trials do not show what they seem to show. Even for my best NEJM trial, which showed something, almost nobody understood what that was! We move forward mostly by realising what our blind alleys were.

Dear Jonathan,

I definitely agree with you. I have read the following trial of yours and admire the way your group maintained the double blinded status of the study.

[Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis.

N Engl J Med. 2004 Jun 17;350(25):2572-81.]

In my opinion optimism combined with realistic approach is the key for achieving practical goals.

Regards.

If typical calcification (chondrocalcinosys) are present

Dear Mr. Kaz and Mr. Jonathan

I would suggest that you may check our 3 papers on use of colchicine in Osteoarthritis. The first study was an open label study on use of colchicine in patients with Osteoarthritis with inflammation with presence of CPPD crystal in synovial fluid. Thereafter we conducted a randomized placebo controlled trial on the use of colchicine in patients with Osteoarthritis of the knee joint with inflammation not adequately respondent to NSAID. The third trial was a double blind placebo controlled trial on the use of colchicine in patients with Osteoarthritis of the knee irrespective of whether inflammation was present or not. All three trials were conducted with background therapy of continuing NSAIDs. Significantly more patients on Colchicine showed 30% or more Pain relief as compared to those on placebo and NSAID.

The two RCT's are available on PubMed. In case you need any of the papers I will send you a PDF copy for your personal use with pleasure.

Personally I treat all my patients with Osteoarthritis with Colchicine and the results is quite gratifying. I would say that they do not become totally pain free but their disease activity becomes tolerable (This is a personal opinion and has not researched)

Siddharth Kumar Das

Prof. and Head of Rheumatology

K.G. Medical University

Lucknow, India

Dear Prof Das,

Thank you kindly for allowing me (everyone on this thread) to share your publication. Plz kindly post the links to your papers here if it possible. Thank you again

Dear Mr Katz

The link for the two studies is given below:

http://onlinelibrary.wiley.com/doi/10.1002/art.10455/abstract

http://www.sciencedirect.com/science/article/pii/S1063458402905169/pdf?md5=569a25da7d8f1e69bd322ef5f697ffd6&pid=1-s2.0-S1063458402905169-main.pdf

Siddharth Das

Not much evidence in favor of colchicine.

I don't use it for OA.

PAtients with OA may show CPP crystals (OA with PP crystals as in the EULAR recommendations for CPPD). The significance is uncertain whether they have a pathogenic role or not.

From a practical point of view, my approach is carefully examining the synovial fluid searching for CPP crystals whinin the leukocytes, even using high augment (1,000x) and contrast phase microscope ( and after considering gout is not a diagnosis due to the presence of urate crystals). If CPP crystals are observed, low dose colchicine or even hydroxicloroquine (Zandg et al ARD 2010, EULAR) may be considered.

Osteoarthitis is not always an inflammatory disease. I do believe that in many cases (with degenerative genesis) osteoarthosis is a more precise name. This disagreement among orthopaedic surgeons is confusing but it still exists. Anyway, colchicine is very effective in controlling acute joint attacks of podagra. In my opinion it should not be presribed in other cases of OA.

Oh, this is also the question I am asking. I take DAS's view. we need a RCT.

After 5 years I return to this question, for those who have stated that it may be useful under specified criteria are somewhat correct. Here is a links: Leung Y-Y, Haaland B, Huebner JL, et al. Colchicine lack of effectiveness in symptom and inflammation modification in knee osteoarthritis (COLKOA): a randomized controlled trial [published online February 7, 2018]. Osteoarthritis Cartilage. doi: 10.1016/j.joca.2018.01.026, that last corespondent has answered , I presume.

Thank you Ying.

For simple OA, colchicine does not help. However, if there is associated CCPD (calcium pyrophosphate deposition disease) with or without chondrocalcinosis, daily prophylactic colchicine can prevent painful crystal-induced flare-ups,

Please go through the article." Treatment significantly reduced mean serum hs-CRP (P = 0.008) and SF CTXI (P = 0.002); treatment tended to reduce inflammatory markers (SF IL-6, IL8, TNFα, CD14 and IL-18), but these differences were not statistically significant." Colchicine may help. It is a cheap drug . So the enthusiasm is less.