Is it safe to initiate prednisone for acute gouty arthritis 2 weeks after undergoing surgery?

From the Guidelines

It is generally safe to start prednisone for gout two weeks after surgery, but consultation with a healthcare provider is necessary to assess the individual's healing status and potential risks. When considering the use of prednisone for gout after surgery, it's essential to weigh the benefits of reducing inflammation against potential risks such as impaired wound healing and increased infection risk 1. The American College of Physicians suggests that corticosteroids, like prednisone, can be an effective and relatively safe option for managing gout, especially in patients without contraindications 1. However, the decision to start prednisone should be made on a case-by-case basis, taking into account the type of surgery, the patient's overall health, and the presence of any conditions that might be exacerbated by corticosteroid use. Key considerations include:

• The patient's current healing status and any signs of infection or complications at the surgical site.
• The presence of conditions such as diabetes, which may be worsened by corticosteroids.
• The potential for drug interactions with other medications the patient is taking.
• Alternative treatments for gout, such as colchicine or NSAIDs, which may be suitable depending on the patient's specific situation and medical history 1. Given the potential risks and benefits, consultation with a healthcare provider is crucial to determine the best course of treatment for gout after surgery, considering the individual's unique circumstances and health status.

From the FDA Drug Label

Corticosteroids can produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression with the potential for corticosteroid insufficiency after withdrawal of treatment. Increased dosage of rapidly acting corticosteroids is indicated in patients on corticosteroid therapy subjected to any unusual stress before, during and after the stressful situation

It is not explicitly stated in the label whether it is okay to start prednisone for gout 2 weeks after surgery. However, considering the patient has undergone recent surgery, which can be a stressful situation, caution is advised. The label suggests that increased dosage of corticosteroids may be indicated in patients subjected to unusual stress, but it does not provide clear guidance on initiating prednisone therapy in this specific scenario. Therefore, a conservative approach would be to exercise caution and consider the potential risks of corticosteroid therapy in a post-surgical patient, including the risk of infection and adrenal insufficiency 2.

From the Research

Gout Treatment with Prednisone after Surgery

• The decision to start prednisone for gout 2 weeks after surgery depends on various factors, including the type of surgery, patient's overall health, and potential interactions with other medications 3.
• According to a study published in 1990, a short course of oral corticosteroid therapy, such as prednisone, can be used effectively for acute gout when NSAIDs are contraindicated 4.
• Another study published in 2014 suggests that low-dose corticosteroids, such as prednisone, may be used as an alternative to colchicine or NSAIDs for prophylaxis of acute gout flares after initiation of urate-lowering therapy 5.
• A 2024 study compares prednisolone with colchicine in terms of non-inferiority in patients with acute gout, and the results may provide evidence for the efficacy of prednisolone in treating acute gout 6.
• In patients undergoing bariatric surgery, a perioperative approach is suggested to prevent gouty attacks, including appropriate hydration, early physical resumption, urate lowering drugs, and nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine and corticosteroids if NSAIDs are ineffective or not tolerated 3.
• Recent guidelines on the management of gout suggest that anti-inflammatory treatment should start as soon as possible, preferably within 24 hours, and the choice of agent, including steroids, should be left to the physician 7.

Potential Risks and Considerations

• The use of prednisone for gout should be carefully considered in patients with certain comorbidities, such as diabetes, hypertension, or osteoporosis, as it may exacerbate these conditions 4, 5.
• Patients should be monitored for potential side effects of prednisone, including increased blood sugar levels, blood pressure, and mood changes 6, 3.
• The dosage and duration of prednisone treatment should be tailored to the individual patient's needs and response to treatment, and should be gradually tapered to minimize the risk of rebound arthropathy or steroid complications 4, 5.