IV Colchicine should not be given to patients who are already receiving maintenance therapy with colchicine. The dose should be reduced in older patients and in patients with renal or hepatic disease. The goal is to prevent recurrent attack of acute gout. Oral colchicine 0.5 to 1.5 mg QD is the most effective dosing. Side effects are uncommon at this dose, and it may be discontinued after the serum urate level becomes normal and stable for 2 to 3 months.
Chronic changes are the result of persistent hyperuricemia and recurrent acute attacks of gout.
Tophi develop mainly in the helix of the ear. Other locations include the ulnar aspects of the forearm, olecranon, and prepatellar bursae, Achilles tendons, and hands. Extra-articular locations for tophus formation included myocardium, pericardium, aortic valves, and extradural spinal regions. May mimic rheumatoid arthritis though generally less symmetric. Characteristic radiographic appearance.