What is the recommended dose of steroid (e.g. prednisone) for managing a gout flare?

Recommended Steroid Dosing for Gout Flare

The recommended dose of oral prednisone for managing a gout flare is 30-35 mg daily (approximately 0.5 mg/kg per day) for 5 days. 1, 2

First-Line Treatment Options for Gout Flares

• Oral corticosteroids (prednisone/prednisolone) at 30-35 mg/day for 3-5 days is a recommended first-line treatment option for gout flares 1
• Alternative prednisone dosing regimens include:
  • 0.5 mg/kg per day for 5-10 days at full dose then stop 1, 2
  • 0.5 mg/kg per day for 2-5 days at full dose followed by tapering for 7-10 days 1, 2
• Other first-line options include NSAIDs at full FDA-approved doses or colchicine (1.2 mg followed by 0.6 mg one hour later on day 1) 3, 1

Route of Administration Options

• Oral prednisone is appropriate for most patients with gout flares 1, 2
• For patients unable to take oral medications, parenteral glucocorticoids are strongly recommended: 3, 1
  • Intramuscular (e.g., triamcinolone acetonide 60 mg) 2
  • Intravenous glucocorticoids 3
  • Intra-articular injections (particularly effective for 1-2 affected joints) 1, 2

Advantages of Corticosteroids

• Corticosteroids are generally safer and a low-cost treatment option compared to other alternatives 1, 2
• Corticosteroids are as effective as NSAIDs for managing gout with fewer adverse effects 1
• A randomized trial showed equivalent efficacy between prednisolone (35 mg once daily) and naproxen (500 mg twice daily) for gout treatment 4

Special Considerations

• For patients with severe renal impairment, corticosteroids are preferred over colchicine or NSAIDs 1
• For severe acute gout attacks or polyarticular involvement, consider combination therapy (e.g., colchicine with oral corticosteroids) 2
• Monitor for potential adverse effects including dysphoria, mood disorders, elevated blood glucose, and fluid retention 1, 2
• Corticosteroids are contraindicated in patients with systemic fungal infections 1
• For patients with diabetes, more frequent blood glucose monitoring is recommended during corticosteroid therapy 1

Treatment Duration

• Continue treatment until the gout attack has completely resolved 1
• A 5-day course at full dose is typically sufficient for oral corticosteroids 1, 2
• Early treatment initiation is crucial for optimal effectiveness 1

Adjuvant Therapies

• Topical ice can be used as an adjuvant treatment for additional pain relief 3, 1
• For prophylaxis during initiation of urate-lowering therapy, low-dose prednisone (<10 mg/day) can be used as a second-line option if colchicine and NSAIDs are not tolerated, contraindicated, or ineffective 2, 5

Common Pitfalls and Caveats

• Failing to start treatment early significantly reduces effectiveness; acute gout should be treated as soon as possible 1
• Continuing urate-lowering therapy during acute flares is now recommended, with appropriate anti-inflammatory coverage 1
• Prophylaxis against flares should be initiated when starting urate-lowering therapy to prevent treatment-induced flares 6, 5