From the Guidelines
Yes, it is generally acceptable to prescribe prednisone for gout that started 2 weeks ago. Prednisone is an effective anti-inflammatory medication for managing gout flares, as supported by the American College of Physicians guideline 1. A typical regimen would be 30-40mg daily for 3-5 days, then tapering down by 5-10mg every 1-2 days until completion, for a total course of about 7-14 days. Some key points to consider when prescribing prednisone for gout include:
- Side effects may include increased blood sugar, mood changes, insomnia, and fluid retention.
- Prednisone works by reducing inflammation in the affected joint by suppressing the immune response that causes the painful swelling.
- While taking prednisone, patients should continue adequate hydration and may use acetaminophen for additional pain relief if needed.
- For long-term management, patients should discuss preventive medications like allopurinol or febuxostat with their healthcare provider, as prednisone only treats the acute flare but doesn't address the underlying high uric acid levels that cause gout, as recommended by the American College of Physicians guideline 1 and the 2016 updated EULAR evidence-based recommendations for the management of gout 1. It's also important to note that the choice of treatment should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved, as stated in the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
From the Research
Gout Treatment and Prednisone
- The use of prednisone for gout treatment is supported by studies, as it is mentioned as a treatment option for acute gout attacks 2 and as a prophylaxis option for gout flares after initiation of urate-lowering therapy 3.
- According to a study, low-dose corticosteroids (such as prednisone) may be used for prophylaxis if low-dose colchicine and low-dose NSAIDs are contraindicated, not tolerated, or ineffective 3.
- Another study suggests that prednisone can be used as a treatment for acute gout flares, and its efficacy is comparable to other treatments such as colchicine and naproxen 4.
Timing of Prednisone Treatment
- There is no specific evidence on the optimal time to start prednisone treatment after an acute gout attack, but it is recommended to start urate-lowering therapy after an acute attack has resolved 5.
- A study suggests that prophylaxis for gout flares should be continued for at least 6 months after initiation of urate-lowering therapy 5.
Alternative Treatment Options
- Other treatment options for gout include NSAIDs, COX-2 inhibitors, colchicine, and interleukin-1 inhibitors such as canakinumab and anakinra 2, 3, 4.
- Anakinra has been shown to be effective in treating acute gout flares and may be a potential treatment alternative for patients who do not respond to other treatments 6, 4.