From the Guidelines
For a gout flare, prednisone is typically prescribed at 30-35mg daily for 3-5 days, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. This dosing is 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. The initial higher dose quickly reduces inflammation, while the short duration prevents rebound flares. Some key points to consider when prescribing prednisone for gout flares include:
- Take the medication with food to minimize gastrointestinal side effects
- Monitor for short-term side effects like increased blood sugar, mood changes, and insomnia
- For patients with diabetes, blood glucose monitoring is important during treatment
- Prednisone is particularly useful when NSAIDs or colchicine are contraindicated due to kidney disease, gastrointestinal issues, or drug interactions
- While treating the acute flare, consider initiating long-term urate-lowering therapy like allopurinol after the flare subsides to prevent future attacks, as recommended by the American College of Physicians guideline on management of acute and recurrent gout 1.
From the Research
Prednisone Dosing for Gout Flare
- The ideal dosing for prednisone in the treatment of gout flare is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that glucocorticoids, which include prednisone, are effective for treating acute gout and have a similar efficacy to NSAIDs but are safer 4.
- Systemic corticosteroids, such as prednisone, have been shown to be effective in treating acute gout attacks, with studies supporting oral and intramuscular use 5.
- The choice of agent for acute gout treatment, including prednisone, is often left to the physician's discretion, with guidelines recommending treatment start as soon as possible, preferably within 24 hours 6.
- Intra-articular, oral, or intramuscular steroids are all described as effective for treating acute gout, but the specific dosing for prednisone is not provided in the studies 6.