From the Guidelines
Prednisone is a recommended treatment option for acute gout flares, particularly for patients who cannot take NSAIDs or colchicine due to contraindications. The typical regimen is 30-40mg daily for 3-5 days, as suggested by the 2016 updated EULAR evidence-based recommendations for the management of gout 1. This dosage is also supported by the American College of Physicians, which recommends the use of low-dose corticosteroids, such as prednisolone at a dose of 35 mg for 5 days, to treat acute gout 1.
Key Considerations
- Prednisone works by reducing inflammation through suppression of inflammatory mediators that cause the intense pain and swelling characteristic of gout attacks.
- It's essential to monitor for side effects such as increased blood sugar, mood changes, fluid retention, and elevated blood pressure while taking prednisone.
- Patients should take prednisone with food to minimize stomach irritation.
- After the acute attack resolves, discuss with your doctor about preventive strategies, including lifestyle modifications and possibly urate-lowering therapy like allopurinol to prevent future attacks.
- Do not stop prednisone abruptly, as this can cause adrenal insufficiency; always follow the prescribed tapering schedule.
Treatment Approach
- The choice of drug(s) 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 1.
- Combination therapy, such as colchicine and an NSAID or colchicine and corticosteroids, can be proposed for patients with particularly severe acute gout, for instance, when flares involve multiple joints 1.
From the Research
Gout Treatment Options
- Gout is a form of inflammatory arthritis characterized by swelling, pain, or tenderness in a peripheral joint or bursa, including the development of a tophus 2.
- Colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids, such as prednisone, are used to relieve pain in adults with acute gout episodes 2, 3.
Role of Prednisone in Gout Treatment
- Prednisone is a corticosteroid that can be used to treat gout flares 3, 4.
- In a cost-effectiveness analysis, prednisone was found to have comparable effects on utility as other gout flare medications, such as naproxen and colchicine 4.
- However, naproxen was found to be the cheapest option when combined with febuxostat, while prednisone was dominated by naproxen in terms of cost-effectiveness 4.
Guidelines for Gout Treatment
- Updated guidelines from the American College of Physicians, the European League Against Rheumatism, and the American College of Rheumatology provide clear guidance on the optimal integration of therapeutic options for gout management 5.
- These guidelines recommend the use of NSAIDs, colchicine, and corticosteroids, such as prednisone, as first-line agents for gout flares 3, 5.