From the Guidelines
The recommended prednisone course for a gout flare is 30-35 mg/day of equivalent prednisolone for 3-5 days. This is based on the 2016 updated EULAR evidence-based recommendations for the management of gout 1. The medication should be taken with food to minimize gastrointestinal side effects. Patients should begin treatment as soon as possible after flare onset for maximum effectiveness. Prednisone works by suppressing inflammation and immune responses that drive the painful symptoms of gout. It's particularly useful when NSAIDs or colchicine are contraindicated due to kidney disease, gastrointestinal issues, or other health concerns.
Some key points to consider when prescribing prednisone for a gout flare include:
- The dose and duration of treatment may vary depending on the severity of the flare and the patient's individual needs 1
- Patients with diabetes should monitor their blood glucose more frequently while taking prednisone, as it can cause increased blood sugar levels 1
- Short-term side effects may include mood changes and insomnia, but these typically resolve after completing the course 1
- While taking prednisone, patients should continue any prescribed urate-lowering therapy (like allopurinol) without interruption.
It's also important to note that corticosteroids, such as prednisone, are considered a first-line treatment option for acute gout, as they are generally safer and have fewer adverse effects compared to NSAIDs 1. However, the decision to use prednisone should be made on a case-by-case basis, taking into account the patient's individual needs and medical history.
From the Research
Recommended Prednisone Course for Gout Flare
- The recommended prednisone course for a gout flare is not explicitly stated in the provided studies, but oral or intramuscular corticosteroids are listed as standard pharmacotherapies for gout flares 2.
- Systemic glucocorticoids (GC) are as effective as nonsteroidal anti-inflammatory drugs (NSAID) but safer, according to moderate quality evidence from three trials 3.
- There is no direct comparison of systemic GC with placebo, and no randomized controlled trials (RCT) assessed intraarticular GC or compared systemic GC with other treatments such as colchicine or interleukin-1 inhibitors 3.
- Low-dose colchicine may be an effective treatment for acute gout when compared to placebo, with low-quality evidence suggesting its benefits may be similar to NSAIDs 4.
- Corticosteroids, including prednisone, are commonly used to treat acute gout, but the optimal dosage and duration of treatment are not well established 5.
Treatment Options for Acute Gout
- Options available for the treatment of acute attacks of gout include:
- NSAIDs
- Colchicine
- Corticosteroids (such as prednisone)
- Corticotropin
- Intra-articular corticosteroids 5
- Combination therapy is often used to treat acute gout, but this practice merits further study 5.
- The most important determinant of therapeutic success is not which treatment is chosen, but rather how soon treatment is initiated 5.