Prednisone Dosing for Gout Flare

The recommended dose of prednisone for treating a gout flare is 0.5 mg/kg per day (approximately 30-35 mg for average adults) 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 treatment options include NSAIDs at full FDA-approved doses, colchicine (within 12 hours of flare onset), or intra-articular corticosteroid injection for 1-2 affected joints 1

Oral prednisone is the most common route of administration for gout flares 2
Intra-articular corticosteroid injection is recommended for involvement of 1-2 large joints 1, 2
Intramuscular triamcinolone acetonide 60 mg, followed by oral prednisone, is another effective option 2

Corticosteroids are recommended as first-line therapy because they are generally safer and a low-cost treatment option compared to other medications 1, 2
They are as effective as NSAIDs for managing gout with fewer adverse effects 1
Corticosteroids are particularly useful in patients with contraindications to NSAIDs or colchicine 2

A 5-day course at full dose is typically sufficient for oral corticosteroids 1, 2
Treatment should continue until the gouty attack has completely resolved 1
Monitor for potential adverse effects including dysphoria, mood disorders, elevated blood glucose, and fluid retention 1, 2

Corticosteroids are a preferred option over colchicine or NSAIDs in patients with severe renal impairment 1
For severe acute gout attacks or polyarticular involvement, consider combination therapy with colchicine and oral corticosteroids 2
Monitor blood glucose levels more frequently during corticosteroid therapy in patients with diabetes 1
Corticosteroids are contraindicated in patients with systemic fungal infections 1

Treat acute gout flares as early as possible for best results 1
For particularly severe acute gout involving multiple joints, combination therapy may be appropriate 1, 2
Acceptable combinations include oral corticosteroids and colchicine, intra-articular steroids with any other modality, and colchicine and NSAIDs 1

Low-dose prednisone (<10 mg/day) can be used as a second-line option for prophylaxis during initiation of urate-lowering therapy if colchicine and NSAIDs are not tolerated, contraindicated, or ineffective 2, 3
Prophylaxis should continue for 3-6 months after initiating urate-lowering therapy 4