Which corticosteroid regimens are recommended for acute gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Prednisone can be given at a dose of approximately 40 mg for 1-3 days, which is then tapered over approximately 2 weeks (tapering more rapidly can result in a rebound flare). Monitor closely for corticosteroid effects. If treatment continues for more than 2 weeks, consider measures to prevent osteoporosis.

Intra-articular long-acting (depot) corticosteroids are particularly useful in patients with a monoarticular flare to help reduce the systemic effects of oral steroids. Ensuring that the joint is not infected before injecting intra-articular corticosteroids is particularly important.

An alternative to corticosteroid administration is to give ACTH (40 IU subcutaneously, with repeat dosing as needed) to induce production of corticosteroid by the patient’s own adrenal glands. Such a regimen does not depend on the patient for proper tapering of prednisone.


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