Can prednisone (corticosteroid) be used to treat a gout flare?

Prednisone for Gout Flare Management

Prednisone is strongly recommended as a first-line treatment option for acute gout flares due to its effectiveness, safety profile, and low cost compared to other options. 1

First-Line Treatment Options for Gout Flares

• Corticosteroids (including prednisone) should be considered as first-line therapy in patients without contraindications because they are generally safer and a low-cost treatment option compared to NSAIDs and colchicine 2
• Prednisone at 0.5 mg/kg per day for 5-10 days at full dose then stop, or alternatively 0.5 mg/kg per day for 2-5 days followed by a 7-10 day taper, is recommended for treating gout flares 1
• Prednisolone at 30-35 mg daily for 5 days has been successfully used to treat acute gout and has shown equivalent efficacy to NSAIDs with fewer adverse effects 2, 1
• Other first-line options include NSAIDs at full FDA-approved doses or colchicine (when given within 12 hours of flare onset) 1, 3

Advantages of Prednisone for Gout Flares

• Steroids are among the most effective anti-inflammatory medications available and have been shown to be as effective as NSAIDs for managing gout, with fewer adverse effects 2
• Corticosteroids are particularly beneficial in patients with contraindications to NSAIDs (such as renal disease, heart failure, or cirrhosis) or colchicine (severe renal impairment) 2, 4
• A short course of oral corticosteroids (30-50 mg prednisone or equivalent initially) can effectively resolve acute gout without rebound arthropathy in most patients 5
• Unlike colchicine, which is most effective only when given within 12 hours of symptom onset, corticosteroids maintain effectiveness even when treatment is initiated later 1, 3

Specific Dosing Recommendations

• American College of Rheumatology recommends prednisone 0.5 mg/kg per day for 5-10 days at full dose then stop 1
• Alternative regimen: prednisone 0.5 mg/kg per day for 2-5 days at full dose then taper for 7-10 days 1
• European League Against Rheumatism recommends prednisolone 30-35 mg daily for 5 days as a fixed dosing regimen 2, 1
• Treatment should be continued until the gouty attack has completely resolved 1

Potential Adverse Effects and Precautions

• Adverse effects associated with short-term corticosteroid use may include dysphoria, mood disorders, elevation of blood glucose levels, and fluid retention 2
• Corticosteroids are contraindicated in patients with systemic fungal infections 2, 1
• In patients with diabetes, blood glucose levels should be monitored more frequently during corticosteroid therapy 1
• Unlike the concerns with long-term use, short courses of corticosteroids for acute gout typically have minimal side effects 5

Combination Therapy for Severe Gout Attacks

• For particularly severe acute gout attacks involving multiple joints, combination therapy may be considered 2, 3
• Acceptable combinations include oral corticosteroids and colchicine, intra-articular steroids with any other modality, or colchicine and NSAIDs 1, 3
• There are concerns about synergistic gastrointestinal toxicity when combining NSAIDs with systemic corticosteroids 3

Alternative Options When Corticosteroids Are Contraindicated

• If corticosteroids are contraindicated, NSAIDs at full FDA-approved doses or colchicine (1 mg followed by 0.5 mg one hour later) can be used 1, 3
• For patients with contraindications to colchicine, NSAIDs, and corticosteroids, IL-1 blockers may be considered for treating flares 2
• Intra-articular corticosteroid injection is an effective option for 1-2 affected joints 1

Treatment Timing and Duration

• Acute gout flares should be treated as early as possible for optimal effectiveness 2, 1
• A 5-day course at full dose is typically sufficient for oral corticosteroids 2, 1
• Continuing urate-lowering therapy during acute flares (with appropriate anti-inflammatory coverage) does not significantly prolong flare duration 1

Prednisone represents an excellent first-line option for gout flare management, offering effective pain relief with a favorable safety profile compared to alternatives like NSAIDs and colchicine, particularly in patients with comorbidities such as renal impairment.