Background/Aim: The efficacy of colchicine has been assessed in hand osteoarthritis; however, no studies have investigated its use in the more severe subtype of hand osteoarthritis, known as erosive hand osteoarthritis (EHOA). This retrospective cohort study investigated whether colchicine therapy could provide symptomatic relief and improve inflammation markers in patients with EHOA. Methods: The study included a total of 43 EHOA patients using colchicine (2×0.5 mg) + paracetamol (3×500 mg) daily (colchicine group) and 43 EHOA patients using only paracetamol (3×500 mg) (standard therapy group). Both groups were evaluated for various parameters. Results: The groups were similar in terms of age, sex distribution, and other sociodemographic variables. The decreases in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels from baseline were significantly greater in the colchicine group (P<0.001). Additionally, the visual analog scale (VAS) and Australian Canadian Osteoarthritis Hand Index (AUSCAN) scores, which include pain, stiffness, function, and total score, were significantly better in the colchicine group at 3 months compared to the standard therapy group (P<0.001). Furthermore, although both groups showed significant improvements in these parameters, the amount of improvement was significantly greater in the colchicine group (P<0.001). Conclusion: The combined use of colchicine and paracetamol improved CRP and ESR levels, VAS score, and all AUSCAN scores in patients with EHOA. Moreover, these benefits were significantly greater than standard therapy with paracetamol alone. Colchicine appears to be an effective therapeutic agent in the treatment of EHOA.