What is the recommended dose of prednisone (corticosteroid) for treating acute gout?

Prednisone Dosing for Acute Gout

For acute gout treatment, oral prednisone should be administered at a starting dose of 0.5 mg/kg per day (approximately 30-35 mg for average adults) for 5-10 days at full dose and then stopped, or alternatively given for 2-5 days at full dose followed by tapering for 7-10 days. 1, 2

First-Line Oral Corticosteroid Regimens

• Prednisone 0.5 mg/kg per day (approximately 30-35 mg for average adults) for 5-10 days at full dose then discontinued 3, 1
• Alternatively, prednisone 0.5 mg/kg per day for 2-5 days at full dose followed by tapering for 7-10 days 1, 2
• Methylprednisolone dose pack (pre-packaged taper) is an appropriate option according to provider and patient preference 1

Alternative Corticosteroid Administration Routes

• Intra-articular corticosteroid injection is recommended for involvement of 1-2 large joints, with dose varying depending on joint size 3, 1
• Intramuscular triamcinolone acetonide 60 mg, followed by oral prednisone, is an effective alternative route of administration 1, 4
• For patients unable to take oral medications, parenteral glucocorticoids (intramuscular, intravenous, or intra-articular) are strongly recommended 2

Treatment Selection Based on Joint Involvement

• For 1-2 large joint involvement: Consider intra-articular corticosteroid injection 3, 1
• For polyarticular involvement or multiple joint involvement: Use oral prednisone regimen 1, 2
• For severe acute gout attacks (≥7/10 on pain scale) or polyarticular involvement: Consider combination therapy with colchicine and oral corticosteroids 3, 1

Monitoring and Response Assessment

• Inadequate response is defined as <20% improvement in pain within 24 hours or <50% improvement at ≥24 hours after initiating therapy 3, 1
• If inadequate response occurs, consider switching to another monotherapy or adding a second recommended agent 3
• Continue treatment until the gouty attack has completely resolved 2
• Monitor for short-term adverse effects including dysphoria, mood disorders, elevated blood glucose levels, and fluid retention 1, 4

Important Considerations and Caveats

• Corticosteroids should be considered as first-line therapy in patients without contraindications as they are generally safer and a low-cost treatment option compared to colchicine 1, 2
• Assess for contraindications to corticosteroids, including systemic fungal infections, uncontrolled diabetes, active peptic ulcer disease, and immunocompromised state, before initiating treatment 1
• For patients with diabetes, more frequent blood glucose monitoring is recommended during the steroid course 4, 2
• Early treatment initiation is crucial for optimal effectiveness; treatment should begin as soon as possible after symptom onset 2
• Avoid long-term corticosteroid use for gout prophylaxis; if needed for prophylaxis during urate-lowering therapy, use low-dose prednisone (<10 mg/day) only when colchicine and NSAIDs are contraindicated 4, 2

Evidence Quality

• The American College of Rheumatology guidelines provide Level A evidence (highest quality) for the effectiveness of oral corticosteroids in treating acute gout 1
• Multiple randomized trials have shown that oral corticosteroids are as effective as NSAIDs for treating acute gout, with fewer adverse events 4, 5
• A short course of oral corticosteroid therapy is effective for acute gout when NSAIDs are contraindicated 1, 5