From the Guidelines
Prednisone 40mg daily is not the recommended dose for acute gout, as the suggested dose is 30-35 mg/day of equivalent prednisolone for 3-5 days. The treatment of acute gout should be initiated as early as possible, and 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.
Key Considerations
- The recommended first-line options for acute flare are colchicine, NSAIDs, oral corticosteroids, or articular aspiration and injection of corticosteroids 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.
- The task force does not prioritize between these options due to a lack of direct comparative evidence, but combination therapy, such as colchicine and an NSAID or colchicine and corticosteroids, can be proposed for patients with particularly severe acute gout 1.
Treatment Regimen
- The typical regimen for oral corticosteroids involves taking 30-35 mg/day of equivalent prednisolone for 3-5 days 1.
- Patients should continue drinking plenty of fluids and may use ice packs for additional pain relief.
- Common side effects of prednisone include temporary mood changes, increased appetite, and insomnia, and patients with diabetes should monitor blood sugar levels closely as prednisone can cause elevations.
Long-term Management
- For long-term gout management, medications that lower uric acid levels (like allopurinol) are recommended rather than repeated courses of prednisone, as chronic steroid use carries significant health risks 1.
From the Research
Treatment of Acute Gout with Prednisone
- The use of prednisone for acute gout has been studied in several clinical trials 2, 3, 4, 5, 6.
- A study from 1990 found that a short course of oral corticosteroid therapy, such as prednisone 30 to 50 mg, can be used effectively for acute gout when NSAIDs are contraindicated 2.
- Another study from 1994 noted that oral steroids may have a small role in acute therapy and seem safe when used over short time spans 3.
- A 2008 Cochrane review found that there is inconclusive evidence for the efficacy and effectiveness of systemic corticosteroids in the treatment of acute gout, but patients did not report serious adverse effects from systemic corticosteroids when used short term 4.
- More recent studies, such as the COPAGO trial, are investigating the non-inferiority of prednisolone compared to colchicine for the treatment of acute gout in primary care 5, 6.
- The COPAGO trial is using a dose of 30 mg prednisolone for 5 days, which is slightly lower than the 40 mg dose in question 5, 6.
Dosage and Efficacy
- The efficacy of 40 mg of prednisone for acute gout is not directly addressed in the available studies, but the 1990 study suggests that a dose of 30 to 50 mg may be effective 2.
- The COPAGO trial may provide more information on the efficacy of prednisolone for acute gout, but the results are not yet available 5, 6.
- It is essential to consult with a healthcare professional to determine the appropriate dosage and treatment plan for acute gout, as individual circumstances may vary 2, 3, 4, 5, 6.