Prednisone Dosing for Knee Inflammation Due to Knee Sprain

For knee inflammation due to a knee sprain, prednisone should be started at 10-20 mg daily for 2-4 weeks if NSAIDs are ineffective. 1

Initial Management Approach

First-line treatment for knee sprain inflammation should be NSAIDs (such as naproxen 500 mg twice daily or meloxicam 7.5-15 mg daily) for 4-6 weeks 1
If NSAIDs fail to control inflammation and pain, low-dose oral prednisone can be initiated at 10-20 mg daily for 2-4 weeks 1
For more severe inflammation with significant pain and functional limitation, the dose may be increased to 20 mg daily, with potential escalation to 1 mg/kg/day if no response is seen after 2-4 weeks 1

Prednisone 1 mg/kg/day (or equivalent) for 2-4 weeks, or until symptoms improve 1
Taper gradually over 4-8 weeks once inflammation subsides 1

A randomized controlled trial showed that low-dose oral prednisolone (7.5 mg/day for 6 weeks) provided clinically relevant reduction in knee pain and improved physical function compared to placebo in patients with knee osteoarthritis 2
The effects of prednisolone remained significant at 12 weeks, suggesting both short-term and sustained benefits 2
Prednisolone therapy also attenuated systemic inflammation markers in patients with knee problems 2

For localized knee inflammation affecting 1-2 joints, intra-articular corticosteroid injection may be considered if oral prednisone at 10 mg/day and NSAIDs are not effective 1
Intra-articular steroid injections provide relatively short-lived benefit (typically 1-4 weeks) but can be effective for acute exacerbations of knee pain 1
Evidence suggests intra-articular steroids are more effective than placebo for pain relief in the short term (ES 1.27) 1

Once symptoms improve, taper prednisone gradually over 4-8 weeks until reaching the lowest effective dose or complete discontinuation 1
Consider tapering by 1 mg decrements every couple of weeks to a month 3
Avoid abrupt discontinuation to prevent rebound inflammation 1

Supplement with calcium (800-1000 mg/day) and vitamin D (400-800 units/day) when initiating prednisone therapy 3
Monitor for potential side effects including bruising, skin-thinning, hypertension, and elevated blood glucose 4
The risk of adverse effects with short-term, low-dose prednisone appears acceptable when weighed against benefits 5
For elderly patients or those with comorbidities, consider starting at the lower end of the dosing range 6

Assess response to treatment after 2-4 weeks 1
If no improvement is seen within 2-4 weeks on initial dosing, consider escalating management approach 1
Conduct functional assessments at follow-up visits to objectively measure improvement 1