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Prospects for the use of colchicine in rheumatic diseases
Summary. Objectives. The aims of this article were to review the literature about the mechanism of action of colchicine in the pathogenesis of acute inflammation associated with gout and to consider the clinical efficacy of colchicine in other chronic inflammatory diseases. Methods. We performed PubMed database searches for relevant studies in the literature. Relevant articles pertaining to the mechanism of action of colchicine and the clinical applications of colchicine in gout and other inflammatory conditions were identified and reviewed. Results. Colchicine has a multiple mechanism of action. The primary mechanism of action of colchicine is tubulin disruption. In gout, the effect of colchicine is more pronounced in conditions caused by the activity of macrophages and neutrophils. This leads to subsequent down regulation of multiple inflammatory pathways and modulation of innate immunity. Colchicine modulates the innate immune response via inhibition of the NALP3 inflammasome. Colchicine also has anti-fibrotic activities and various effects on endothelial function. Many of these cellular processes can be found in other diseases involving chronic inflammation. The anti-inflammatory action of colchicine and its complex mechanism of action substantiates its potential use in other rheumatic diseases. The therapeutic use of colchicine has extended beyond gouty arthritis and familial Mediterranean fever, to osteoarthritis, pericarditis, and atherosclerosis. Colchicine has unique anti-inflammatory properties that may be beneficial in various cardiovascular conditions. Current data suggests that colchicine may reduce the composite rate of cardiovascular adverse outcomes in a range of patients with established cardiovascular disease. Furthermore, colchicine reduces rates of recurrent pericarditis, post-pericardiotomy syndrome, and peri-procedural atrial fibrillation following cardiac surgery. Conclusion. Further understanding of the mechanisms of action underlying the therapeutic efficacy of colchicine will lead to its potential use in a variety of diseases.
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