Prednisone Dosing for Acute Gout
For acute gout attacks, oral prednisone should be administered at 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 7-10 day taper. 1
Recommended Corticosteroid Regimens
Oral Prednisone Options:
- Standard regimen: 0.5 mg/kg per day for 5-10 days at full dose then stop 1
- Tapered regimen: 0.5 mg/kg per day for 2-5 days at full dose, then taper for 7-10 days 1
- Fixed dose option: 30-35 mg daily for 3-5 days 1, 2
- Methylprednisolone dose pack: As an alternative to prednisone 1
Alternative Corticosteroid Administration Routes:
- Intra-articular injection: Dose varies depending on joint size (can be used with or without oral therapy) 1
- Intramuscular: Triamcinolone acetonide 60 mg, followed by oral prednisone as above 1
Clinical Decision-Making for Gout Treatment
When to Choose Corticosteroids:
Corticosteroids should be considered first-line therapy in patients with:
Considerations for Corticosteroid Use:
- Corticosteroids are as effective as NSAIDs for managing gout with fewer adverse effects 1
- They are generally safer and a lower-cost treatment option compared to other alternatives 1
- Short courses of oral corticosteroids rarely cause significant adverse effects 3
Treatment Approach Based on Joint Involvement
- 1-2 joints: Consider intra-articular corticosteroid injections 2
- Multiple joints/polyarticular gout: Systemic therapy preferred 2
- Severe attacks: Consider combination therapy (e.g., colchicine + corticosteroids) 1, 2
Important Caveats and Precautions
- Treatment should be initiated within 24 hours of symptom onset for optimal outcomes 2
- Avoid corticosteroids in patients with systemic fungal infections 1
- Monitor for potential adverse effects with longer-term use (dysphoria, mood disorders, elevated blood glucose, immune suppression) 1
- In patients with diabetes or uncontrolled hypertension, NSAIDs or colchicine may be preferred over corticosteroids if not contraindicated 2
Prophylaxis During Urate-Lowering Therapy
For long-term prophylaxis during urate-lowering therapy, low-dose prednisone (<10 mg/day) can be used as a second-line option when colchicine and NSAIDs are not tolerated, contraindicated, or ineffective 1.
The evidence supports that corticosteroids are equally efficacious to NSAIDs and colchicine for acute gout treatment, with potentially fewer adverse effects in certain patient populations 1, 4.