From the Guidelines
Prednisone 40mg daily for 5 days is an effective treatment for acute gout. This short-course oral corticosteroid regimen helps reduce inflammation and pain during gout flares. The typical dosing can be 40mg daily for 5 days, though some providers may use a tapering dose starting at 40mg and gradually decreasing over 5-7 days. Prednisone should be taken with food to minimize stomach irritation, and the full course should be completed even if symptoms improve. It's essential to note that while prednisone treats the acute attack, it doesn't address the underlying cause of gout (elevated uric acid levels). Patients should stay well-hydrated, avoid alcohol, and limit purine-rich foods during treatment. Prednisone works by suppressing the inflammatory response that occurs when urate crystals deposit in joints, which reduces swelling, redness, and pain. This medication is particularly useful for patients who cannot take NSAIDs or colchicine due to contraindications such as kidney disease, gastrointestinal issues, or drug interactions 1.
Some key points to consider:
- The American College of Physicians recommends using oral corticosteroids, such as prednisone, to treat acute gout in patients who cannot take NSAIDs or colchicine 1.
- A study published in the Annals of Internal Medicine found that prednisolone at a dose of 35 mg for 5 days was effective in treating acute gout, with fewer adverse effects compared to NSAIDs 1.
- The 2016 updated EULAR evidence-based recommendations for the management of gout suggest using oral corticosteroids, such as prednisolone, at a dose of 30-35 mg/day for 3-5 days to treat acute gout flares 1.
- It's crucial to weigh the benefits and risks of using prednisone, considering its potential adverse effects, such as dysphoria, mood disorders, elevation of blood glucose levels, immune suppression, and fluid retention 1.
Overall, prednisone 40mg daily for 5 days is a viable treatment option for acute gout, especially for patients with contraindications to other medications. However, it's essential to carefully evaluate the individual patient's needs and medical history before initiating treatment.
From the Research
Treatment of Acute Gout with Prednisone
- Prednisone is a corticosteroid that can be used to treat acute gout 2.
- The efficacy and safety of systemic corticosteroids, such as prednisone, in the treatment of acute gout have been studied, but the evidence is inconclusive 2.
- A study found that patients with gout did not report serious adverse effects from systemic corticosteroids, such as prednisone, when used short-term 2.
- Another study found that prednisone was given to 9% of patients with acute gout in the emergency department, either during the visit or as a prescription 3.
Dosage and Duration of Prednisone Treatment
- The dosage and duration of prednisone treatment for acute gout can vary, but one common regimen is 40mg daily for 5 days 3.
- However, there is limited evidence to support the use of this specific dosage and duration, and more research is needed to determine the optimal treatment regimen 2.
Comparison with Other Treatments
- Prednisone is one of several treatment options for acute gout, including non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and uricosuric agents 4, 5, 6.
- The choice of treatment depends on various factors, including the patient's medical history, comorbidities, and preferences 4, 5, 6.
- Systemic corticosteroids, such as prednisone, may be a safe alternative to NSAIDs and colchicine, especially for patients with certain comorbidities or contraindications 2.