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

Prednisone Dosing for Acute Gout Flares

For acute gout flares, prednisone should be administered at a dose of 30-35 mg daily for 3-5 days. 1

Recommended Corticosteroid Regimen for Gout Flares

The European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) guidelines recommend oral corticosteroids as an effective treatment option for acute gout flares, particularly in patients with contraindications to NSAIDs or colchicine.

• Standard oral regimen: Prednisone 30-35 mg daily for 3-5 days 1
• Alternative administration routes:
  • Intra-articular injection: Appropriate when only 1-2 joints are affected 1
  • Intramuscular/intravenous: Methylprednisolone 0.5-2.0 mg/kg 1

Comparative Efficacy of Treatment Options

Oral corticosteroids have been shown to be equally effective to NSAIDs in treating acute gout flares. A randomized controlled trial demonstrated that prednisolone (35 mg once daily for 5 days) was equivalent to naproxen (500 mg twice daily for 5 days) in pain reduction for acute gout 2.

Treatment options for acute gout flares include:

1. Oral corticosteroids: Prednisone 30-35 mg daily for 3-5 days
2. NSAIDs: Various options including naproxen 500 mg twice daily
3. Colchicine: Low-dose regimen (1.2 mg initially, followed by 0.6 mg after 1 hour)

Special Considerations

• Renal impairment: Corticosteroids are preferred over NSAIDs and colchicine in patients with renal disease, heart failure, or cirrhosis 1
• Pregnancy: Oral, intramuscular, or intra-articular glucocorticoids are recommended as the best treatment option for acute gout attacks during pregnancy 1
• Timing: Treatment should be initiated as early as possible after symptom onset for maximum effectiveness 1

Prophylaxis During Urate-Lowering Therapy

When initiating urate-lowering therapy (ULT), prophylaxis against acute flares is strongly recommended:

• Duration: Continue prophylaxis for 3-6 months after starting ULT 3
• Options:
  • Low-dose colchicine (0.5-1.0 mg daily)
  • Low-dose NSAIDs
  • Low-dose prednisone (approximately 7.5 mg daily) 1, 4

Potential Pitfalls

• Inadequate duration: A short course (3-5 days) is typically sufficient for most gout flares, but some patients may require longer treatment
• Abrupt discontinuation: Consider a short taper if treating for longer than 5 days to avoid rebound flares
• Monitoring: Be aware of potential side effects of corticosteroids, especially in patients with diabetes, hypertension, or osteoporosis
• Combination therapy: Consider combining with other modalities (ice, rest, elevation) for optimal symptom relief

Prednisone at 30-35 mg daily for 3-5 days provides effective relief for acute gout flares with a favorable risk profile, particularly in patients who cannot tolerate NSAIDs or colchicine.