Colchicine for Gout Treatment

I found this very interesting article and the surprise in the concluding paragraph.  The URL to the subject is http://www.hopkinsarthritis.org/arthritis-news/gout-news/arthritis-news-optimal-colchicine-dosage-for-acute-gout-explored/.  The article, in part, concluded, from editorial comment,  that lowering serum levels may be a more effective treatment than anything but low doses of Colchicine (two 0.6 Mg then one 0.6 mg later).  Please read the article copied from the above link to form your on opinion. A big thanks to the researchers for this study.

Gout

Despite being used for decades as a primary treatment for acute gout, optimal colchicine dosing has not been systematically evaluated.  This is potentially important, as higher doses of colchicine can frequently be associated with the undesired consequence of severe diarrhea and gastrointestinal distress.  Here, Terkeltaub et al (Arthritis Rheum 2010; 62(4): 1060) explore different dosing strategies for colchicine in the first randomized, blinded, placebo controlled trial, named AGREE (Acute Gout Flare Receiving Colchicine Evaluation)

Methods

Adult men and postmenopausal women with confirmed gout and a history of frequent flares were randomized to one of three treatment groups:

1. low dose colchicine- 1.2 mg followed by 0.6 mg in one hour (followed by placebo doses on subsequent hours): total dose=1.8 mg
2. high dose colchicine – 1.2 mg followed by 0.6 mg per hour for 5 hours: total dose 4.8 mg
3. all placebo

Participants were enrolled at 54 centers in the U.S. in 2007-2008.  Patients used supplied study medications within 12 hours of the onset of flare symptoms, with symptoms monitored in a diary.  Post-flare study visits were planned for within 48 hours of flare onset.  The primary endpoint was the proportion of patients with a 50% or greater reduction in pain within 24 hours of study drug.

Results

Among the 575 randomized patients, 185 had a gout flare and used the study medication.  There were 52 (28%) in the high dose group, 74 (40%) in the low dose group, and 59 (32%) in the placebo group.  Mean age was 52 years, with the majority of participants being male (95%), Caucasian (83%), with longstanding gout.  Tophi were uncommon (9%).  Despite a mean serum urate concentration of 8.8 mg/dl, less than a third were receiving urate lowering therapy.

Table. Efficacy Outcomes According to Treatment Allocation
	High Dose (n=52)	Low Dose (n=74)	Placebo (n=58)	p-value high dose vs. placebo	p-value low dose vs. placebo
50% reduction in pain at 24 hours	33%	38%	16%	0.034	0.005
≥ 50% reduction in pain at 32 hours	37%	42%	17%	0.022	0.002
≥ 2 unit reduction in pain at 24 hours	35%	43%	17%	0.037	0.002
≥ 2 unit reduction in pain at 32 hours	39%	46%	17%	0.012	0.001

Rescue medications were used significantly less frequently in the colchicine groups, and did not differ by low-dose vs. high-dose allocation.

For safety, there were no serious adverse events.  Diarrhea was observed in 77% of high dose colchicine treated patients compared to 23% of low-dose and 14% of placebo treated patients.  Severe diarrhea was observed in 19% of high dose patients, compared to none in the other groups.  Vomiting was only observed in the high dose colchicine group.  These differences were all statistically significant.

Conclusions

Low dose colchicine was as efficacious as high dose in relieving the pain of recurrent gout flares with a more favorable side effect profile.

Editorial Comment

Colchicine has been widely used to treat acute gout for decades, yet its usage has been based primarily on style than hard data.  This study definitively supports the use of this low dose regimen over higher doses.  Even with higher doses, more than 60% of patients did not have at least a 50% reduction in the their symptoms in the first 24-32 hours.  This suggests that chronic urate lowering, rather than flare management, should be the focus of care in patients with frequent attacks, a modality that was absent in many of these patients.  Whether other treatments for acute gout (i.e. NSAIDs or glucocorticoids) are superior to this regimen has not been studied.

End Quote

http://www.agawatrain.com/packages-schedule/ looks like a good trip to take for a retired family.  I am putting it on my to-do list.  If we get our RV then this is a definite for the late August or pre-colors season.  We get an all day train ride and a casino stay for a pretty cheap price.  I am no much of a gambler so they won’t make too much from me 🙂

Church, Sunshine and Some Work Too

We went to Fremont Community Church this morning and watched the new pastor being consecrated by Director Pastor Don Gifford.  What a day.  Boy, was I wrong for a long time about the director.  It is amazing how a snap judgement can be so wrong.  Perhaps it is the environment or perhaps it is just a bad day, anyway, this was a good day.

After church we came home and I had some lunch and then took a little nap before going out to Matt’s t work on Quickbooks installation in the multi-user mode.  Since it was QB Pro it handles only 3 users in the 2014 version.  The whole deal took about 4 hours to install, commission and check out all details.

The afternoon was bright and sunny and getting warm so i was glad to finish and head towards the ranch.

Working

This week has been a work week.  I have been in the process of bringing two computers online to replace two machines that are aging and failing. Today, this morning actually, I received a call that said the Quickbooks had failed and would I get in there to “fix” it.  Well, I did arrive later and rebooted the machine and lo and behold the problem was solved for the near term.  The biggest part of this job is to figure out how the software work and anticipate how the customer will use it.  It is interesting and I enjoy the venue.

Tomorrow it is supposed to be rainy so it will be nice to be inside working on things.  Right now I am listening to IRLP and Allstar using my vhf HT’s.  With that I have to go.  BFN.

Birds are singing

I awake each morning to the singing of birds.  It is that time of year that the generations get renewed and revitalized.  The weather the past two days has been good and warm.  Today we try a new church – a Fremont one.  I will add to this days post later in the day.

RV Search

We are looking for an RV. Presently the search is concentrating on Class A versions.  They seem to be a great value for not too old ones.  The search is focusing on 30 – 34′ units that have a generator and at least one slide.  I would like a diesel but these are more rare than I thought they would be.

After I left to do some computer work for a local business, SAM further expanded the search to include much smaller units.  She told me they looked too small for long term occupation. I am glad for that since I know I would not be happy for long stumbling over each other.

I am sure you will hear more from us on the Rv subject over time so I will end the discussion here.

Cold Continuing & Leaden Skies As Well

We definitely came home too early this year.  I envy those still down there. My last post said about the same thing.  I have spent the time between posts resting, staying inside and looking for new peojects like finding a RV.  The first cut was presented, without too much success, to my spouse.  Anyway, I shall persist until I feel comfortable with the market.  After that is a grey area but at least if keeps my mind occupied with visions of a new adventure.

The truth be told, I miss my boat and my boating friends.  I doubt that I will ever recover from this malady since new things on the shrinking horizon do not seem as exciting nor as focusing.  However, when your path is strewn with pebbles and you are constantly on guard it becomes easy to capitulate.  What a boring life is on land so I guess I am resigned to finding energy somewhere and make life interesting.  I have been thinking of applying for a crew position on a boat going somewhere.

Cold & Snowy Today

We started the day with a drive to Angola for a meeting and then went to Walmart for groceries.  I waited in the car so I could yak on the radio while SAM went inside.  Just I was about to give up and go inside SAM appeared so we drove home in the snow.

I made several trips from the building to the ham shack where I was terminating a LMR-400 cable that will be the antenna lead in for the Allstar node that has been idle for quite some months.  When it gets warmer, I will climb the tower and mount it below or above the IRLP Slim Jim antenna.  The slim jim antenna is matched with a Motorola GM300 radio running about 20 watts.  The Allstar node has a tyt-9000d vhf radio with a  a Diamond X-50A antenna and running about 7 watts.

We had a good dinner tonight with canned Salmon and Veggies.  I took part of my new pill regimen tonight.  In a few days, when the other ones run out I will switch and be taking some new ones that may or may not help.  In any case, they will be less expensive that the solid gold one I have been taking.

Trying the new online editor

This size is the Heading 1 level.

This size is the level 2.

Level 3 is right here.

And Level 4 is even smaller.

I think I like the level three heading and text.  After I publish it I will go a view it to make sure.  The day here was overcast and rainy with the rain really starting around 1500 hours.  Anyway this should be sufficient for the test.

FL to IN – short but long

The roadway was full of people from Florida right on up to Knoxville Good Friday.  Atlanta was a zoo and we lost lots of time there so the planned home run was cut off and we stayed at the Days Inn North in Knoxville. This was a first time stay and it was OK – room was a bit noisy but the view of our rig in the parking lot made up for that.  The hot breakfast was mediocre with lots of little things missing but we were the first ones there and that made up for the shortcomings.  All-in-all our $62 room was pretty good as it was clean with new carpets.  We would stay again.

The final leg home was on uncrowded roads but we went thru Cincinnati instead of taking the I-74 to Indy.  This was a mistake as the road construction and slow traffic was irksome.  Still we arrived home about 1730 hours and we turned on the house and unloaded the cab of the truck and the car.

On the way home we discussed Sabre 34 and this boat might hold some promise.  Still in my deck of cards is the Pearson 35 and Seaward 26RK.  There may be others that interest me but the role of the boat at this time in undefined.  One thing is known, I must be able to single hand the boat for extended periods on inter-coastal, near shore use.  The occasional open ocean  passage must be safe for a single hander and this might leave the Seaward wanting.  Unlike our other boats, seasonal living aboard comfort is not an issue as we will be out for a couple of weeks to a month at most.  We will be planning and researching for a while.

BTW – we made a whirlwind trip to Texas for the wedding on my niece Kristen.  I now feel so beat that I just cannot beat the feeling of fatigue. I slept 11 hours straight and that is an almost unheard of event.  Hum, I might be getting old.