Can prednisone help with gout?

From the Guidelines

Yes, prednisone can effectively help with gout. Prednisone is a corticosteroid medication that reduces inflammation and is commonly prescribed for acute gout attacks when other treatments aren't suitable. A typical regimen involves 30-40mg daily for 3-5 days, then tapering down over 1-2 weeks. For severe cases, higher doses may be used initially. Prednisone works by suppressing the inflammatory response that causes the intense pain, redness, and swelling characteristic of gout attacks. It's particularly useful for patients who cannot take NSAIDs or colchicine due to kidney problems, stomach issues, or other contraindications. While taking prednisone, it's essential to take it with food to minimize stomach irritation and follow the prescribed tapering schedule to avoid withdrawal symptoms. Prednisone doesn't address the underlying cause of gout (high uric acid levels), so it's typically used as a short-term solution for acute attacks while other medications like allopurinol or febuxostat may be prescribed for long-term management to prevent future attacks 1.

Some key points to consider when using prednisone for gout include:

• The American College of Physicians recommends corticosteroids, NSAIDs, or colchicine as first-line treatments for acute gout 1.
• Prednisone has been shown to be as effective as NSAIDs in reducing pain and inflammation in gout patients, with fewer adverse effects 1.
• The typical dose of prednisone for gout is 30-40mg daily for 3-5 days, followed by a tapering schedule to avoid withdrawal symptoms 1.
• Patients with kidney problems, stomach issues, or other contraindications may not be able to take NSAIDs or colchicine, making prednisone a useful alternative 1.
• Long-term use of prednisone can lead to adverse effects such as dysphoria, mood disorders, elevation of blood glucose levels, immune suppression, and fluid retention 1.

From the Research

Gout Treatment with Prednisone

• Prednisone is a corticosteroid that can be used to treat gout, a common inflammatory arthritis characterized by the deposition of urate crystals 2.
• The efficacy of prednisone in treating gout has been studied in several trials, with some showing that it can be an effective alternative to non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine 3, 4.
• A randomized controlled trial found that oral prednisolone was equivalent to naproxen in reducing pain in patients with monoarticular gout, with a reduction in pain score of 44.7 mm and 46.0 mm, respectively 4.
• Another study found that the addition of topical ice therapy to oral prednisolone and colchicine resulted in significantly greater pain reduction at one week, with a mean pain reduction of 4.4 cm on a 0 to 10 cm visual analogue scale (VAS) 5.
• However, the quality of the evidence for the use of prednisone in treating gout is generally considered low to moderate, and more research is needed to fully understand its efficacy and safety 5, 3.

Comparison with Other Treatments

• Prednisone has been compared to other treatments for gout, including NSAIDs, colchicine, and other corticosteroids 3, 4.
• A study found that intramuscular triamcinolone acetonide was compared to oral indomethacin, and oral prednisolone was compared to oral indomethacin, with no clinically relevant differences found between the treatments 3.
• Another study found that oral prednisolone and naproxen were equally effective in reducing pain in patients with gout, with similar adverse effects 4.

Safety and Adverse Effects

• The safety and adverse effects of prednisone in treating gout have been studied, with most studies finding that it is generally well-tolerated and safe for short-term use 3, 4.
• However, long-term use of prednisone can be associated with more serious adverse effects, such as osteoporosis, diabetes, and cardiovascular disease 2.
• Patients with gout should be closely monitored for adverse effects when taking prednisone, and the lowest effective dose should be used for the shortest duration necessary 3, 4.