When you’re in the midst of a painful gout flare, you want it to stop — fast. But there’s more than one to treat a flare, so doctors have to weigh the pros and cons of the various options. Those include non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen, which reduce inflammation, as well as a medication called colchicine. The exact mechanism of action for colchicine is unknown, but it may interfere with the body’s (painful) immune response that kicks in when uric acid crystallizes in a joint.
All drugs have side effects. High doses of colchicine tend to be effective, but they can cause severe GI side effects. Lower doses of colchicine can also be used, but it hasn’t been clear whether cutting the dose really preserves the benefit while reducing side effects.
Meanwhile, naproxen has the potential to cause some stomach upset or raise your blood pressure.
So should your doctor choose naproxen or low-dose colchicine? A new study — the first one to directly compare these treatment options — comes out in favor of naproxen.
In this study, which appears in the journal Annals of the Rheumatic Diseases, UK researchers conducted a multicenter open-label trial in which nearly 400 adults who showed up at a primary care doctor’s office with a gout flare were randomly assigned to get either low-dose colchicine (500 mcg three times per day for four days) or an initial 750 mg dose of naproxen followed by an additional 250 mg of naproxen every eight hours for a week.
According to their findings, there was “no difference in pain intensity over seven days between people with a gout flare randomized to either naproxen or low-dose colchicine. Naproxen caused fewer side effects supporting naproxen as first-line treatment for gout flares in primary care in the absence of contraindications.”
In other words, naproxen provided the same benefit with fewer risks.
In a correspondence response that was published in the same journal, the trial authors clarified that “naproxen should be considered as the first-line treatment in primary care in the absence of contraindications.”
People with cardiovascular risk factors, for instance, might be better off taking colchicine. Corticosteroid drugs, like prednisolone, might also be a better choice for certain gout patients.
“While randomized trials have compared NSAIDs and prednisolone, future research should compare the effectiveness and safety of colchicine and corticosteroids, particularly in patients with contraindications to NSAIDs,” the authors wrote in their discussion.
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Roddy E, et al. Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care. Annals of the Rheumatic Diseases. October 2019. doi: http://dx.doi.org/10.1136/annrheumdis-2019-216154.