From the Guidelines
Prednisone is a recommended treatment for acute gout flares, with a typical regimen of 30-40mg daily for 3-5 days, as supported by high-quality evidence from the American College of Physicians 1.
Key Considerations
- The choice of treatment should be based on the presence of contraindications, the patient’s previous experience with treatments, and the number and type of joint(s) involved, as outlined in the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
- Corticosteroids, such as prednisone, are effective treatments to reduce pain in patients with acute gout, with fewer adverse effects compared to NSAIDs, as shown in a study published in the Annals of Internal Medicine 1.
- The dose of prednisone may vary depending on the severity of the flare, with higher doses of 40-60mg used initially for severe cases.
- It is essential to take prednisone with food to minimize stomach irritation and to rest the affected joint, apply ice, and stay well-hydrated while taking the medication.
Potential Side Effects and Interactions
- Prednisone can cause side effects, including increased blood sugar, mood changes, and sleep disturbances, and may require dose adjustments in patients with diabetes, heart disease, or other chronic conditions.
- Patients should be aware of potential interactions between prednisone and other medications, such as strong P-glycoprotein and/or CYP3A4 inhibitors.
Long-term Management
- While prednisone treats the acute flare, it does not address the underlying cause of gout, and additional medications like allopurinol may be recommended for long-term management once the flare subsides, as suggested by the American College of Physicians 1.
- Lifestyle modifications, such as weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise, may also be recommended to reduce the risk of future gout flares, as outlined in the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
From the Research
Treatment Options for Gout Flare Ups
- Systemic corticosteroids, such as prednisone, have been shown to be effective in treating acute gout flare ups, with similar efficacy to NSAIDs 2, 3.
- The use of oral prednisolone has been compared to NSAIDs in the treatment of acute gout, with results showing comparable efficacy and a slightly safer strategy 4.
- Guidelines for the management of gout suggest that anti-inflammatory treatment should start as soon as possible, preferably within 24 hours, and that the choice of agent should be left to the physician 5.
Efficacy and Safety of Prednisone
- Studies have shown that oral prednisolone (30-35 mg/day) is comparable to NSAIDs (naproxen at 500 mg/day or indomethacin at 50-100 mg/day) in terms of pain relief and efficacy 4.
- Prednisolone has been shown to reduce the risk of certain adverse events, such as indigestion, nausea, and vomiting, but may increase the risk of skin rashes 4.
- The use of prednisone may be a suitable alternative to NSAIDs for patients with acute gout, particularly those with contraindications to NSAIDs 2, 3.
Comparison to Other Treatments
- Systemic corticosteroids, such as prednisone, have been shown to be as effective as NSAIDs, but with a safer profile 3.
- Colchicine, another treatment option for acute gout, has been shown to be effective, particularly at low doses, but may have a higher risk of adverse events compared to prednisone 2, 3.
- Interleukin-1 inhibitors, such as canakinumab, have also been shown to be effective in treating acute gout, but may have a higher risk of adverse events compared to prednisone 2, 3.