What is the recommended dose of prednisone (corticosteroid) for treating gout?

Prednisone Dosing for Acute Gout

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

First-Line Treatment Options for Gout Flares

• Oral corticosteroids (prednisone/prednisolone) at 0.5 mg/kg per day is an appropriate first-line treatment option for acute gout attacks 1, 2
• Alternative corticosteroid regimens include:
  • Fixed dose of prednisolone 30-35 mg daily for 5 days 2
  • Methylprednisolone dose pack with subsequent follow-up treatment as needed 1
• Other first-line options include:
  • NSAIDs at full FDA-approved doses 1, 2
  • Colchicine (if started within 36 hours of symptom onset) 1, 2
  • Intra-articular corticosteroid injection for involvement of 1-2 large joints 1, 2

Specific Prednisone Dosing Protocols

• Standard regimen: Prednisone 0.5 mg/kg per day for 5-10 days at full dose then stop 1, 2
• Alternative regimen: Prednisone 0.5 mg/kg per day for 2-5 days at full dose then taper for 7-10 days 1, 2
• For severe gout attacks (≥7/10 pain or polyarticular involvement), combination therapy may be appropriate, including oral corticosteroids with colchicine 1, 2

Route of Administration Options

• Oral: Prednisone at 0.5 mg/kg per day as described above 1
• Intramuscular: Triamcinolone acetonide 60 mg followed by oral prednisone as described above 1
• Intra-articular: Dosing varies depending on joint size, can be used alone or with oral therapy 1

Treatment Duration and Monitoring

• Continue treatment until the gout attack has completely resolved 1, 2
• A 5-10 day course at full dose is typically sufficient for most gout attacks 1, 2
• Monitor for potential adverse effects including elevated blood glucose, fluid retention, and mood changes, particularly in elderly patients 2, 3

Special Considerations

• Corticosteroids are often preferred over NSAIDs or colchicine in patients with:
  • Renal impairment 2, 3
  • Gastrointestinal problems 2, 3
  • Contraindications to NSAIDs or colchicine 1, 4
• For prophylaxis of gout attacks during urate-lowering therapy initiation, 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

Treatment Response Assessment

• Inadequate response is defined as <20% improvement in pain score within 24 hours or <50% improvement at ≥24 hours after initiating therapy 1
• If inadequate response occurs, consider switching to another monotherapy or adding a second recommended agent 1

Corticosteroids have been shown to be as effective as NSAIDs for managing gout with fewer adverse effects, making them an excellent option for many patients, particularly those with comorbidities that would complicate the use of other treatments 2, 4.