From the Guidelines
For an acute gout attack, prednisolone at a dose of 35 mg for 5 days is recommended, as it has been shown to be effective in reducing pain with fewer adverse effects compared to NSAIDs 1. This recommendation is based on high-quality evidence that corticosteroids, NSAIDs, and colchicine are effective treatments to reduce pain in patients with acute gout. Some key points to consider when using steroids for acute gout include:
- Starting treatment as early as possible in the attack for optimal results
- Continuing usual urate-lowering therapy during the attack if already on it
- Being aware of potential side effects such as temporary blood glucose elevation, mood changes, and insomnia
- Monitoring blood glucose more frequently in patients with diabetes
- Ensuring adequate hydration and rest of the affected joint as adjunctive measures during treatment
- Considering alternative treatments such as NSAIDs or colchicine if corticosteroids are contraindicated It's also important to note that corticosteroids are generally safer and a low-cost treatment option, making them a good first-line choice for patients without contraindications 1.
From the Research
Recommended Steroid Dose for Acute Gout
- The recommended steroid dose for an acute gout attack is not consistently defined across all studies, but some evidence suggests the use of prednisone 30 to 50 mg or its equivalent, initially, and gradually tapered over 10 days 2.
- Another study proposes the use of 30 mg prednisolone for 5 days as a potential treatment for acute gout 3.
- Systemic corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use 4.
- The choice of steroid dose may depend on the individual patient's condition, comorbidities, and potential adverse effects.
Considerations for Steroid Use
- Corticosteroids are probably a reasonable choice for patients in whom colchicine and NSAIDs may be hazardous or for those with a history of previous intolerance to these drugs 5.
- Patients with previous or recent gastrointestinal bleeding, those receiving anticoagulant therapy or with haemorrhage diathesis, and those with renal insufficiency are at risk of developing severe adverse effects from NSAID administration, making corticosteroids a potential alternative 5.
- Intra-articular corticosteroid therapy is indicated for the treatment of acute mono or oligoarticular gouty arthritis in aged patients, and in those with co-morbid conditions contraindicating therapy with either NSAIDs or colchicine 6.