The addition of colchicine produced significantly greater symptomatic benefit at 16 and 20 weeks than intraarticular steroid and piroxicam alone in patients with knee OA with inflammation.

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Objective. To determine if colchicine added to nimesulide may have a beneficial effect on osteoarthritis (OA) of the knee. Methods. Colchicine 0.5 mg twice daily or placebo was added to nimesulide (a nonsteroidal antiinflammatory drug) in 36 patients with OA of the knee in a randomized, double-blind, placebo-controlled trial over a 5-month period. Results. The 30% improvement rate at 20 weeks was higher in the colchicine group than in the control group receiving placebo, as measured by total Western Ontario and McMaster University Osteoarthritis scores (57.9% versus 23.5%) and visual analog scale for index knee pain (52.6% versus 17.6%) (primary measures of response). The significance persisted on combined analysis by Mantel-Haenszel test (P ‫؍‬ 0.062). Comparison of means also showed significant improvement in the colchicine group versus the control group in a multivariate analysis performed using T 2 test (P ‫؍‬ 0.0115). Conclusion. Among patients with OA of the knee, the group receiving colchicine plus nimesulide exhibited significantly greater symptomatic benefit at 20 weeks than did the control group receiving nimesulide plus placebo. KEY WORDS: Colchicine; Knee osteoarthritis.Osteoarthritis (OA) is traditionally considered to be an inherently noninflammatory disease, but acute flares are accepted as a component in the course of advanced OA (1). Inflammation in OA is frequently secondary to the presence of calcium-containing crystals, and leads to the production of interleukin-1 (IL-1), an important mediator of cartilage breakdown in OA (2). Because calcium-containing crystals are frequently seen in severe OA (3,4), and colchicine has been shown to be beneficial in preventing calcium crystal-induced inflammation (pseudogout) (5), it is hypothesized that colchicine could have symptom-modifying or even disease-modifying effects in patients with OA. Even though the magnitude of benefit observed with colchicine in acute pyrophosphate arthropathy is not remarkable, a 12-week open clinical trial (6) showed that a regimen consisting of colchicine ϩ piroxicam ϩ intraarticular steroid was better than piroxicam ϩ intraarticular steroid alone in patients with knee OA exhibiting inflammation and calcium pyrophosphate dihydrate (CPPD) crystals in joint fluid. A randomized double-blind placebocontrolled trial (Das SK: unpublished observations) showed significantly better symptom-modifying effects when colchicine was added to piroxicam plus intraarticular steroid over a 5-month period in patients with knee OA presenting with signs of inflammation irrespective of whether CPPD crystals were demonstrable.Crystal deposition in OA is probably not an "on-off" phenomenon as previously thought (7), and may not only contribute to acute flares of inflammation in OA, but may also contribute to chronic low-grade, persistent, clinically nonapparent inflammation (1). This study was undertaken in patients with OA of the knee irrespective of the presence of clinical signs of inflammation. The purpose was to evaluate the benefit conferred...

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