What is the dose and frequency of prednisone (corticosteroid) for treating gout?

Prednisone Dosing for Acute Gout

For acute gout attacks, prednisone should be administered at a dose of 0.5 mg/kg per day for 5-10 days at full dose then stopped, or for 2-5 days at full dose followed by a taper over 7-10 days. 1

Recommended Corticosteroid Regimens for Acute Gout

Oral Prednisone Options:

• Standard dosing: 0.5 mg/kg per day 1
• Fixed dosing example: 30-35 mg daily for 5 days 1

Duration Options:

1. 5-10 days at full dose then stop, OR
2. 2-5 days at full dose then taper for 7-10 days 1

Alternative Corticosteroid Formulations:

• Methylprednisolone Dose Pack: Pre-packaged tapering dose 1
• Intramuscular option: Triamcinolone acetonide 60 mg, followed by oral prednisone as above 1
• Intra-articular injection: Dose varies depending on joint size (can be used with or without oral therapy) 1

Clinical Decision-Making for Gout Treatment

First-Line Treatment Options:

1. Corticosteroids (including prednisone) - recommended as first-line in patients without contraindications due to safety profile and low cost 1
2. NSAIDs
3. Colchicine

When to Choose Prednisone:

• When NSAIDs are contraindicated (renal disease, heart failure, cirrhosis)
• When colchicine is contraindicated (renal/hepatic impairment, use of CYP3A4 inhibitors)
• For patients with multiple joint involvement or severe attacks (may consider combination therapy) 1

Important Considerations

Timing of Treatment:

• Acute flares should be treated as early as possible 1
• Early initiation of any treatment leads to better effectiveness

Safety Considerations:

• Monitor for adverse effects with prolonged use: mood disorders, elevated blood glucose, immune suppression, fluid retention 1
• Contraindicated in patients with systemic fungal infections 1

Prophylaxis:

• Low-dose prednisone (<10 mg/day) can be used as second-line prophylaxis when colchicine and NSAIDs are not tolerated, contraindicated, or ineffective 1

Evidence Quality

The recommended prednisone dosing regimen for acute gout is supported by expert consensus (Level C evidence) according to the American College of Rheumatology guidelines 1. Studies have shown that prednisolone at 35 mg for 5 days is as effective as NSAIDs for managing gout with fewer adverse effects 1.

While there are multiple effective treatment options for acute gout, corticosteroids like prednisone offer a favorable safety profile compared to NSAIDs and colchicine, making them particularly valuable for patients with comorbidities that limit the use of other treatments.