From the Research
A typical prednisone taper for gout involves starting with 30-40mg daily for 3 days, then reducing by 5-10mg every 1-3 days until reaching zero, over a total period of 7-14 days. For example, a specific regimen might be 40mg daily for 3 days, then 30mg for 3 days, 20mg for 3 days, 10mg for 3 days, and 5mg for 2 days. The medication should be taken in the morning with food to minimize gastrointestinal side effects and sleep disturbances. While taking prednisone, patients should continue their usual gout medications like allopurinol or febuxostat, as prednisone only treats the acute inflammation, not the underlying high uric acid levels. Prednisone works by suppressing the inflammatory response that causes pain and swelling in gout attacks. Potential side effects include increased blood sugar, mood changes, fluid retention, and increased infection risk. Patients with diabetes should monitor their blood sugar closely while on prednisone. The taper is necessary because abrupt discontinuation can cause adrenal insufficiency after the body has adjusted to the external steroid source.
Key Considerations
- The treatment of gout flares and urate-lowering therapy is crucial in managing the condition, as highlighted in a 2022 review 1.
- Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids are first-line agents for gout flares, with IL-1β antagonists being effective for arresting flares but considered salvage therapies due to cost-effectiveness 1.
- A 2020 review emphasizes the importance of diagnosing gout using validated clinical prediction rules and the role of colchicine, NSAIDs, and corticosteroids in relieving pain in acute gout episodes 2.
- The most recent update on gout pharmacotherapy from 2025 highlights standard pharmacotherapies for gout flares, including colchicine, NSAIDs, and oral or intramuscular corticosteroids, with an emphasis on emerging therapies and personalized treatment approaches 3.
- A 2021 Cochrane review provides low-quality evidence that low-dose colchicine may be an effective treatment for acute gout when compared to placebo, with benefits similar to NSAIDs, but high-dose colchicine may increase adverse events 4.
Recommendations
- Prednisone should be tapered gradually to avoid adrenal insufficiency, with a typical taper involving a reduction by 5-10mg every 1-3 days until reaching zero over 7-14 days.
- Patients should continue their usual gout medications while on prednisone, as it only treats acute inflammation.
- Monitoring for potential side effects, such as increased blood sugar and infection risk, is crucial, especially in patients with diabetes.