Low-dose colchicine after 12 hours from the onset of gout flare

According to the EULAR guidelines, in gout flares colchicine is recommended within 12 hours of the onset of symptoms. Because most patients frequently present after this time, the recommendation concerns self-administration of colchicine and treatment of subsequent flares. Can we use low-dose colchicine if the patient presents after 12 hours from the onset of symptoms? Or should we prefer nonsteroidal anti-inflammatory drugs or steroids?

George Nuki: There is some evidence that colchicine is much more effective if it is used within a short period of time, 12 hours, 24 hours, some people say even 36 hours. I do not think the evidence is strong enough to say that it should under no circumstances be used if the attack has been going on for longer than that.

There are other considerations in the choice between using a nonsteroidal anti-inflammatory drug or colchicine. Many of the gout patients should not be treated with a nonsteroidal drug because of some renal insufficiency, previous history of a serious peptic ulcer perforation or bleed, and so forth. I think you have to consider the individual patient very carefully.