What is the recommended dose of prednisone (corticosteroid) for treating a gout flare?

Prednisone Dosing for Acute Gout Flares

For acute gout flares, oral prednisone should be prescribed at 30-35 mg daily for 3-5 days, followed by either stopping the medication or tapering over 7-10 days. 1

First-Line Treatment Options

Corticosteroids, including prednisone, are one of three first-line treatment options for acute gout flares:

1. Oral corticosteroids:

   • Prednisone 30-35 mg daily for 3-5 days 1
   • Can be given as full dose for 5-10 days then stopped OR for 2-5 days at full dose followed by a 7-10 day taper 1
   • Consider as first-line therapy in patients without contraindications due to safety profile and low cost 1

2. NSAIDs: With proton pump inhibitor if appropriate

   • Avoid in patients with severe renal impairment, heart failure, or cirrhosis 1

3. Colchicine: Loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1

   • Avoid in severe renal impairment or with P-glycoprotein/CYP3A4 inhibitors 1
   • Low-dose regimen (1.2 mg followed by 0.6 mg 1 hour later) is as effective as higher doses with fewer side effects 1

Treatment Algorithm for Gout Flares

1. Assess patient for contraindications:

   • For prednisone: Systemic fungal infections, uncontrolled diabetes
   • For NSAIDs: Renal disease, heart failure, cirrhosis, history of GI bleeding
   • For colchicine: Severe renal/hepatic impairment, use of CYP3A4/P-glycoprotein inhibitors

2. Select appropriate therapy based on:

   • Patient's previous experience with treatments
   • Time since flare onset (colchicine most effective within 12 hours)
   • Number and type of joints involved
   • Comorbidities

3. For severe flares (multiple large joints or polyarticular):

   • Consider combination therapy: colchicine + NSAIDs or oral corticosteroids + colchicine 1

Corticosteroid Administration Options

• Oral: Prednisone 30-35 mg daily for 3-5 days 1
• Intramuscular: Triamcinolone acetonide 60 mg, with or without oral follow-up 1
• Intra-articular: Dose varies depending on joint size 1

Important Considerations and Pitfalls

• Timing matters: Treat gout flares as early as possible; educate patients to self-medicate at first warning symptoms 1
• Avoid common errors:
  • Don't underdose prednisone (doses below 30 mg are likely ineffective)
  • Don't continue high-dose prednisone beyond 5-10 days without tapering
  • Don't forget to consider prophylaxis when initiating urate-lowering therapy
• Adverse effects of corticosteroids include dysphoria, mood disorders, elevated blood glucose, immune suppression, and fluid retention 1
• Monitoring: For short courses of prednisone (3-5 days), minimal monitoring is needed in patients without diabetes or other contraindications

Corticosteroids have been shown to be as effective as NSAIDs for managing gout with fewer adverse effects, making them an excellent choice, particularly in patients with contraindications to NSAIDs or colchicine 1.