Recommended Prednisone Dosing for Gout Flare

The recommended dose of prednisone for treating 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 Flare

Oral corticosteroids (prednisone/prednisolone) at 30-35 mg/day for 3-5 days is recommended as a first-line treatment option for gout flares 1
Other first-line 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
Corticosteroids should be considered as first-line therapy in patients without contraindications because they are generally safer and a low-cost treatment option compared to other medications 1, 2

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
Methylprednisolone dose pack (pre-packaged taper) is also an appropriate option according to provider and patient preference 2

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 of administration 2

Corticosteroids are preferred over colchicine or NSAIDs in patients with severe renal impairment 1
For patients with diabetes, more frequent monitoring of blood glucose levels is recommended during corticosteroid therapy 1
Corticosteroids are contraindicated in patients with systemic fungal infections 1
In patients with cardiovascular disease or heart failure, short durations of low-dose glucocorticoids are considered safe when colchicine cannot be tolerated 3

Initial combination therapy is appropriate for patients with severe acute gout attacks, particularly with multiple joint involvement 1
Acceptable combinations include oral corticosteroids and colchicine, intra-articular steroids with any other modality, and colchicine and NSAIDs 1

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

Failing to start treatment early significantly reduces effectiveness; acute gout should be treated as soon as possible 1
NSAIDs should be avoided in patients with cardiovascular disease or heart failure 3
When initiating urate-lowering therapy, concomitant anti-inflammatory prophylaxis (including low-dose prednisone <10 mg/day as a second-line option) should be used to prevent treatment-induced flares 4, 1
Prophylaxis should be continued for 3-6 months after initiating urate-lowering therapy 4, 1