What is the typical dosage of prednisone (corticosteroid) for treating a gout flare?

Prednisone Dosing for Gout Flares

For gout flares, prednisone should be administered at a dose of 0.5 mg/kg per day for 5-10 days at full dose, then discontinued; or alternatively, 2-5 days at full dose followed by tapering for 7-10 days. 1, 2

Standard Dosing Regimens

• The American College of Rheumatology (ACR) recommends oral prednisone or prednisolone at a starting dose of at least 0.5 mg/kg per day for 5-10 days, followed by discontinuation 1
• An alternative regimen is 2-5 days at full dose, followed by tapering for 7-10 days, and then discontinuation 1
• The European League Against Rheumatism recommends prednisolone 30-35 mg daily for 5 days as a fixed dosing regimen 2
• A methylprednisolone dose pack is also considered an appropriate option according to provider and patient preference 1

Administration Considerations

• Oral corticosteroids are recommended when intra-articular joint injection is impractical (e.g., polyarticular involvement, patient preference) 1
• For severe acute gout attacks (≥7/10 pain) or polyarticular involvement, combination therapy may be appropriate, including oral corticosteroids with colchicine 1
• Treatment should be continued until the gouty attack has completely resolved 2

Alternative Corticosteroid Administration Routes

• For involvement of 1-2 joints, intra-articular corticosteroids are an effective option, with dosing based on the size of the involved joint(s) 1
• An alternative regimen is intramuscular single dose (60 mg) triamcinolone acetonide, followed by oral prednisone or prednisolone 1
• Intra-articular corticosteroid therapy can be used in combination with oral corticosteroids, NSAIDs, or colchicine 1

Efficacy and Safety Considerations

• Oral prednisolone (35 mg once daily for 5 days) has been shown to be equally effective as naproxen in treating gout arthritis 3
• Corticosteroids are recommended as a first-line therapy in patients without contraindications as they are generally safer and a low-cost treatment option 2
• Corticosteroids are as effective as NSAIDs for managing gout with fewer adverse effects 2
• Corticosteroids are preferred over colchicine or NSAIDs in patients with severe renal impairment 2

Monitoring and Precautions

• Monitor for potential adverse effects including dysphoria, mood disorders, elevated blood glucose, and fluid retention 2
• In patients with diabetes, blood glucose levels should be monitored more frequently during corticosteroid therapy 2
• Corticosteroids are contraindicated in patients with systemic fungal infections 2

Alternative First-Line Options for Gout Flares

• NSAIDs at full FDA-approved doses 2
• 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 2
• For prophylaxis during urate-lowering therapy, lower doses are used: prednisone at approximately 7.5 mg daily or colchicine 0.5-0.6 mg daily for up to 6 months 4, 2

Remember that treating acute gout flares as early as possible provides the best results, and the choice of therapy should consider the patient's comorbidities and contraindications 2.