26 Sept 2023 • Acute calcium pyrophosphate crystal arthritis(also known as pseudogout) causes intense joint pain mainly affecting older patients. Because guidance and evidence remain scarce, management of this disease relies on expert opinion. A recent study aimed to compare the safety and short-term equivalence of low-dose colchicine with oral prednisone in older patients with acute calcium pyrophosphate crystal arthritis.

WHAT DID THE STUDY FIND?

• In this open-label, multicenter, randomized trial at six hospitals in France, 95 older patients (mean age, 80); with acute pseudogout received colchicine (1.5 mg on day 1, and 1 mg on day 2) or prednisone (30 mg on days 1 and 2); both groups also received acetaminophen or tramadol for 24 hours. Acute arthritis affected mainly the knee (48%), wrist (20%), or ankle (13%)
• In this trial, A 2-day regimen of low-dose colchicine or prednisone had similar short-term efficacy. Potentially important side effects included diarrhea in 22% of colchicine recipients and elevated blood pressure and hyperglycemia in 11% and 6%, respectively, of prednisone recipients.

Because one in five patients who received colchicine experienced diarrhea, and because colchicine has potentially important drug-drug interactions (e.g., with statins), the choice of which drug to prescribe should be based on safety. Finally, clinicians typically prescribe longer courses of colchicine or prednisone for acute pseudogout (e.g., 7 days). Whether the 2-day regimens used in this trial are as effective as longer regimens is unknown.

Source: NEJM | Read full story