Prednisone Dosing for Acute Gout
The recommended dose of prednisone for treating acute gout is 0.5 mg/kg per day (approximately 30-35 mg for average adults) for 5-10 days at full dose, then stopped, or alternatively given for 2-5 days at full dose followed by tapering for 7-10 days. 1, 2
Dosing Regimens
- Oral prednisone at 0.5 mg/kg per day (typically 30-35 mg) for 5-10 days at full dose then stop 1
- Alternatively, prednisone 0.5 mg/kg per day for 2-5 days at full dose then taper for 7-10 days 1, 2
- Methylprednisolone dose pack (pre-packaged taper) is also an appropriate option according to provider and patient preference 1
- Treatment should continue until the gouty attack has completely resolved 3
Alternative Administration Routes
- Intra-articular corticosteroid injection is recommended for involvement of 1-2 large joints, with dose varying depending on joint size 1, 2
- Intramuscular triamcinolone acetonide 60 mg, followed by oral prednisone, is a recommended alternative route 1
Treatment Selection Considerations
- Corticosteroids should be considered as first-line therapy in patients without contraindications due to their safety profile and low cost 1, 2
- For severe acute gout attacks or polyarticular involvement, consider combination therapy with colchicine and oral corticosteroids 1, 2
- Oral corticosteroids are particularly beneficial when NSAIDs are contraindicated 4
- Early treatment initiation is crucial for optimal effectiveness 2
Monitoring and Response
- Monitor for response, with inadequate response defined as <20% improvement in pain within 24 hours or <50% improvement at 24 hours 3, 1
- Assess for potential adverse effects including dysphoria, mood disorders, elevated blood glucose levels, and fluid retention 1
- In clinical trials, prednisolone (35 mg daily) has shown equivalent efficacy to naproxen for acute gout treatment 5
Contraindications and Precautions
- Assess contraindications to corticosteroids, including systemic fungal infections, uncontrolled diabetes, active peptic ulcer disease, and immunocompromised state 1
- For patients with diabetes, monitor blood glucose levels more frequently during corticosteroid therapy 2
- Corticosteroids are preferred over colchicine or NSAIDs in patients with severe renal impairment 2
Prophylaxis During Urate-Lowering Therapy
- 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 3, 1
- Prophylaxis should continue for at least 6 months, or 3 months after achieving target serum urate if no tophi are detected 3