[Treatment of acute microcrystalline inflammation]

The treatment of acute crystal-induced inflammatory episodes is based on two major classes of drugs, colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs). In its capacity to inhibit leukocyte influx into the inflammatory site, colchicine demonstrates its remarkable anti-inflammatory properties in gouty attacks, for which it is a real therapeutic test. Nevertheless, at usual dosages, colchicine often induces gastrointestinal irritation manifested by diarrhoea. Other side effects (in particular haematologic) are rare but severe in case of liver or kidney failure, which are classic contraindications to this treatment. NSAIDs, by inhibiting local prostaglandin synthesis, are also highly effective in gouty attacks. This ubiquitous property nonetheless leads to side effects, mainly gastro-intestinal and renal. In gouty attacks, clinical steps include a diagnostic work-up seeking an aetiological cause, whereas episodes of chondrocalcinosis or apatite-induced rheumatism are treated symptomatically (rest of the joint, NSAIDs, sometimes colchicine, or local infiltration of cortisone derivatives).