From the Guidelines
The recommended oral prednisone dose regimen for acute gout is 30-35 mg/day of equivalent prednisolone for 3-5 days. This dose regimen is based on the 2016 updated EULAR evidence-based recommendations for the management of gout, which suggests that oral corticosteroids are a recommended first-line option for acute flares of gout 1. The medication should be taken as soon as possible after the onset of an acute gout attack, and patients should be educated to self-medicate at the first warning symptoms.
Key Considerations
- The choice of drug should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved 1.
- Colchicine and NSAIDs should be avoided in patients with severe renal impairment, and colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors 1.
- Patients should be monitored for potential side effects, including elevated blood glucose, especially in diabetic patients, and should not stop the medication abruptly to avoid adrenal insufficiency.
Lifestyle Advice
In addition to the recommended oral prednisone dose regimen, patients with gout should receive advice regarding lifestyle, including weight loss if appropriate, avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals, and excessive intake of meat and seafood 1. Low-fat dairy products should be encouraged, and regular exercise should be advised.
Treatment Goals
The primary goal of treatment is to reduce inflammation and alleviate symptoms, and oral corticosteroids like prednisone are effective in achieving this goal 1. By following the recommended dose regimen and lifestyle advice, patients with acute gout can experience significant improvements in their symptoms and quality of life.
From the Research
Oral Prednisone Dose Regimen for Acute Gout
- The recommended oral prednisone dose regimen for acute gout is not universally established, but several studies provide guidance on its use 2, 3, 4, 5.
- A study from 1990 suggests that a short course of oral corticosteroid therapy, such as prednisone 30 to 50 mg or its equivalent, initially, and gradually tapered over 10 days, can be used effectively for acute gout when NSAIDs are contraindicated 3.
- A 2016 randomized trial compared oral prednisolone with oral indomethacin in patients with acute gout and found that both treatments had similar analgesic effectiveness, with no major adverse events reported 4.
- Another study from 2008 found that oral prednisolone (35 mg once a day) and naproxen (500 mg twice a day) were equally effective in the initial treatment of gout arthritis over 5 days, with similar adverse effects between groups 5.
- The evidence suggests that oral prednisone can be a safe and effective treatment option for acute gout, particularly when NSAIDs are contraindicated or not tolerated 3, 4, 5.