From the Guidelines
Prednisone is a recommended treatment option for acute gout flares, with a typical regimen of 30-40mg daily for 3-5 days, followed by a gradual taper over 7-14 days. This medication works by reducing inflammation in the affected joint by suppressing the immune response to urate crystals 1. The American College of Physicians recommends choosing corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout, with a strong recommendation and high-quality evidence 1.
Key Considerations
- Prednisone should be used as a short-term treatment for acute gout attacks rather than for long-term management.
- For ongoing gout prevention, medications like allopurinol or febuxostat are more appropriate.
- Patients with diabetes should monitor blood sugar levels closely while on prednisone, as it can cause significant elevations.
- Prednisone is particularly useful for patients who cannot take NSAIDs due to kidney problems, heart disease, or gastrointestinal issues, making it a valuable alternative in the treatment arsenal for acute gout attacks.
Monitoring and Side Effects
- Monitor for side effects including increased blood sugar, mood changes, fluid retention, and elevated blood pressure while taking prednisone.
- Take prednisone with food to minimize stomach irritation.
- The use of corticosteroids, such as prednisone, has been shown to be as effective as NSAIDs for managing gout, with fewer adverse effects 1.
Treatment Guidelines
- The American College of Physicians recommends discussing benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks 1.
- 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.
From the Research
Treatment of Gout with Prednisone
- Prednisone, a corticosteroid, is used to treat acute gout flares 2, 3, 4.
- Standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids, such as prednisone 2.
- Corticosteroids, including prednisone, are effective in treating acute gout, with moderate quality evidence showing they are as effective as NSAIDs but safer 4.
- Intra-articular corticosteroids, which can include prednisone, are described as effective for acute gout treatment, although there is limited evidence to support their safety and efficacy in this setting 5.
Comparison with Other Treatments
- Prednisone, as a systemic corticosteroid, appears safer than NSAIDs and can be an alternative when NSAIDs are contraindicated 4.
- Low-dose colchicine is safer than high-dose colchicine, but there is no direct comparison between prednisone and colchicine in terms of safety and efficacy for acute gout treatment 4.
- Urate-lowering therapies, such as allopurinol and febuxostat, aim to prevent gout flares and are used in conjunction with anti-inflammatory treatments like prednisone for acute flares 2, 3.
Safety and Efficacy
- The safety and efficacy of prednisone for acute gout treatment are supported by moderate quality evidence, showing it to be effective and safer than NSAIDs 4.
- However, the use of intra-articular glucocorticoids, which could include prednisone, lacks direct evidence for acute gout treatment, although they may be safe and effective based on their use in other conditions like osteoarthritis 5, 6.