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

Prednisone Dosing for Gout Flare

For treating acute gout flares, oral 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 for 7-10 days. 1

First-Line Treatment Options for Gout Flare

The treatment of gout flares involves several medication options, with corticosteroids being one of the recommended first-line therapies:

• Oral corticosteroids (prednisone/prednisolone) at 30-35 mg/day for 3-5 days 1
• NSAIDs at full FDA-approved doses 1
• Colchicine (within 12 hours of flare onset) at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 1
• Intra-articular corticosteroid injection for 1-2 affected joints 1

Specific Prednisone Dosing Recommendations

Oral Prednisone Regimens:

• Standard dosing: Prednisone 0.5 mg/kg per day for 5-10 days at full dose then stop 1
• Alternative regimen: Prednisone 0.5 mg/kg per day for 2-5 days at full dose then taper for 7-10 days 1
• Fixed dosing: Prednisolone 30-35 mg daily for 5 days 1
• Methylprednisolone Dose Pack: Can be used as an initial treatment option 1

Intramuscular Option:

• Triamcinolone acetonide 60 mg intramuscularly, followed by oral prednisone as described above 1

Considerations for Corticosteroid Selection

Corticosteroids should be considered as first-line therapy in patients without contraindications because:

• They are generally safer and a low-cost treatment option 1
• They are as effective as NSAIDs for managing gout with fewer adverse effects 1
• They are appropriate when colchicine and NSAIDs are contraindicated or not tolerated 1

Combination Therapy for Severe Gout Attacks

For patients with severe acute gout attacks, particularly with multiple joint involvement:

• Initial combination therapy is an appropriate option 1
• Acceptable combinations include:
  • Oral corticosteroids and colchicine 1
  • Intra-articular steroids with any other modality 1
  • Colchicine and NSAIDs 1

Monitoring and Duration

• Continue treatment until the gouty attack has completely resolved 1
• For oral corticosteroids, a 5-day course at full dose is typically sufficient 1
• Monitor for potential adverse effects associated with corticosteroid use, including dysphoria, mood disorders, elevated blood glucose, and fluid retention 1

Special Considerations

• Patients with severe renal impairment: Corticosteroids may be preferred over colchicine or NSAIDs 1
• Patients with diabetes: Monitor blood glucose levels more frequently during corticosteroid therapy 1
• Patients with systemic fungal infections: Corticosteroids are contraindicated 1

Treatment Timing

• Treat acute gout flares as early as possible for best results 1
• Starting urate-lowering therapy during an acute flare (with appropriate anti-inflammatory coverage) does not significantly prolong flare duration 1, 2