From the Guidelines
For acute gout flares, prednisone should be prescribed at a dose of 35 mg for 5 days, as this regimen has been shown to be effective in reducing symptoms with minimal adverse effects. This recommendation is based on high-quality evidence from the American College of Physicians, which suggests that corticosteroids, such as prednisone, are a safe and effective treatment option for acute gout 1. The use of prednisone for acute gout is supported by its ability to suppress inflammation and immune responses that drive gout attacks, thereby reducing pain and swelling.
Some key points to consider when prescribing prednisone for acute gout include:
- Starting treatment as soon as possible after symptoms begin for maximum effectiveness
- Taking the medication with food to minimize gastrointestinal side effects
- Monitoring blood glucose levels closely in patients with diabetes, as prednisone can cause elevations
- Continuing any prescribed urate-lowering therapy at the usual dose while treating the acute attack, as stopping these medications during a flare can worsen symptoms
It's also important to note that prednisone is generally safer and has fewer adverse effects compared to other treatment options, such as NSAIDs, which can cause dyspepsia, gastrointestinal perforations, ulcers, and bleeding 1. However, corticosteroids are contraindicated in patients with systemic fungal infections or known contraindications, and long-term use can lead to adverse effects such as dysphoria, mood disorders, elevation of blood glucose levels, immune suppression, and fluid retention 1.
From the Research
Dosing of Prednisone for Gout
- The optimal dose and duration of prednisone for gout prophylaxis are unknown and require further investigation 2
- A short course of oral corticosteroid therapy, such as prednisone 30 to 50 mg or its equivalent, initially, and gradually tapered over 10 days, can be used effectively for acute gout when NSAIDs are contraindicated 3
- Systemic glucocorticoids, including prednisone, are as effective as NSAIDs but safer for treating acute gout 4
- Corticosteroids, such as prednisone, pose little risk when used in the short-term and may be preferred in patients with contraindications to colchicine or NSAIDs 5
Duration of Prednisone Treatment
- A short course of oral corticosteroid therapy, such as prednisone, can be used for 10 days 3
- The exact duration of prednisone treatment for gout is not well established and may vary depending on the individual patient's response to treatment 2, 4