Ancient and inexpensive drug promising for the future of patients with osteoarthritis Colchicine reduces the number of knee and hip replacements by thirty percent

Patients with osteoarthritis have painful and stiff joints. The current treatment consists of painkillers or major joint replacement surgery. A study conducted by Radboud university medical center and Sint Maartenskliniek now shows that colchicine, an ancient remedy for gout, is probably effective against osteoarthritis.

About one and a half million Dutch people suffer from osteoarthritis. The cartilage of one or more of their joints is damaged, the bone situated under the cartilage changes, and their joints are often inflamed. Osteoarthritis is painful and severely restricts patients' freedom of movement. Currently, the only treatment options are painkillers and major joint replacement surgery. That may be about to change. A study conducted by Sint Maartenskliniek in Nijmegen and Radboud university medical center gives strong indications that an age-old remedy for the treatment of gout is also effective against osteoarthritis.

Colchicine

The studied drug is colchicine, which has been used to suppress inflammation in gout since the first century AD. Years ago, Jan Hein Cornel, Professor of Cardiology at Radboud university medical center, and colleagues came up with the idea that this drug could also work against cardiovascular diseases. Cornel explains: ‘Inflammation plays an important role in those conditions as well. And we were proved right: Our study conducted in more than 5,000 cardiovascular patients revealed that colchicine reduced the risk of a heart attack, angioplasty, bypass, or stroke by thirty percent.'

Calin Popa, rheumatologist at the Sint Maartenskliniek, was impressed by these results and thought: this drug may also mitigate inflammation in osteoarthritis. He contacted Cornel, who was immediately enthusiastic, and together they made a plan. They wanted to determine how many of the cardiovascular patients who participated in the colchicine study received a new knee or hip.

Safe and cheap

Michelle Heijman, researcher at the Sint Maartenskliniek, performed the study. ‘The drug does indeed appear to work against osteoarthritis. In the group treated with colchicine, the number of patients who received a new knee or hip was more than thirty percent lower than in the placebo group. Because it is such an old drug, we know that it is safe. And it is easy to use: each day one tablet that the general practitioner can prescribe.'

Popa also sees a promising future for colchicine in the treatment of osteoarthritis: 'There are other drugs that also seem to have an effect on osteoarthritis, but they are either less safe or very expensive. Colchicine only costs several tens of euros annually. Because osteoarthritis is so common, the cost savings could be enormous.'

Follow-up study

Patients with osteoarthritis cannot yet receive treatment with colchicine. Because data from a study conducted in cardiovascular patients were used, doctors cannot yet prescribe colchicine for osteoarthritis. That is why Popa and Cornel want to conduct a follow-up study that is specifically aimed at osteoarthritis. 

‘If we can confirm that colchicine works, that is fantastic news’, says Popa. We can finally offer osteoarthritis patients a safe and effective therapy that significantly improves their quality of life. Furthermore, it may delay or even prevent major surgery in some cases, which reduces healthcare costs. In short: a win-win-win situation.’

About the publication

This study was published in the Annals of Internal Medicine: Association of Low-Dose Colchicine With Incidence of Knee and Hip Replacements. M.W.J. Heijman, A.T.L. Fiolet, A. Mosterd, J.G.P. Tijssen, B.J.F. van den Bemt, A. Schut, J.W. Eikelboom, P.L. Thompson, C.H.M. van den Ende, S.M. Nidorf, C.D. Popa, J.H. Cornel. DOI: 10.7326/M23-0289

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