Prednisone for gout: Dosage, safety, and more

In this article:

• Can you take prednisone for gout?
• What is the right dosage of prednisone for gout?
• Are there any side effects of taking prednisone for gout?
• Frequently asked questions about prednisone and gout

In this article

• Can you take prednisone for gout?
• What is the right dosage of prednisone for gout?
• Are there any side effects of taking prednisone for gout?
• Frequently asked questions about prednisone and gout

Most people anticipate joint pain and stiffness with injury or age. However, a gout attack can significantly disrupt daily activities, causing sufferers to shuffle and wince with certain movements. That’s where corticosteroids like prednisone can help. It isn’t a cure for gout, but by reducing joint inflammation, prednisone can help relieve the symptoms that come with it. 

Can you take prednisone for gout?

You can. However, prednisone isn’t a treatment for gout itself but for the acute pain and inflammation gout can cause. Gout is an inflammatory disease that stems from a high uric acid concentration, a byproduct created when the body breaks down natural substances called purines. The kidneys typically filter out most uric acid, but uric acid crystals can accumulate in the joints if too much is present or the kidneys aren’t functioning properly. This often occurs in the big toe but can affect any joint and sometimes multiple joints at once. 

“Prednisone is used because anything that increases or decreases the uric acid level in the body, including gout treatment, can precipitate a gout flare,” says Dr. Christina Downey, M.D., a rheumatologist at Loma Linda University Health. “This is when the person has a red, painful, swollen joint that’s sensitive. In that case, we need something that will work quickly to control that inflammation. For some patients, that medication is prednisone.”

Prednisolone (Prednisolone is the active form, whereas prednisone has to be converted to prednisolone by the liver before it can work), a powerful anti-inflammatory medication, has been shown effective as a first-line treatment for gout in studies such as those from 2016 and 2017. It inhibits the body’s immune system response, decreasing the inflammation and discomfort associated with gout. It might work quickly, too. Some people may feel some relief within an hour. For others, it might take a day or two to reach its full effects, but since gout attacks can last 7–14 days, that’s still early in the timeline.

However, “prednisone is only a ‘band-aid’ in treating acute flares of gout,” says Dr. Jason E Liebowitz, M.D., a rheumatologist in the Columbia University Department of Medicine. “More long-term management of gout should include urate-lowering therapy, such as allopurinol. Prophylactic colchicine is typically started with allopurinol for the first three to six months to reduce the risk of incident gout flares.”

What is the right dosage of prednisone for gout?

Prednisone is available in two forms: oral medication and injection. Doctors often administer it orally but may opt for an injection if the condition is confined to a specific joint. 

The drug’s label recommends doses of 5–60 mg per day. According to the Johns Hopkins Arthritis Center, the typical starting dose of prednisone for gout management is 30–40 mg daily. “We want to use as low of a dose as possible that’s going to get the job done for a short period of time,” Dr. Downey says. “For an acute flare, depending on the patient’s body weight, they might start at 40 or 20 mg or even up to 60 mg. And then our rapid taper is typically done over the next five to seven days.” Used as a prophylactic to prevent future attacks, Dr. Downey says the dosage is typically only 5 mg. 

Ultimately, “it has to be tailored to the specific patient,” she continues. “Some patients have badly controlled diabetes, so you want a much lower dose on a shorter course for that person. Some people might have very high body weight and need higher doses. Or some people might be very small and only need a smaller dose.”

Are there any side effects of taking prednisone for gout?

Prednisone might treat some of gout’s most frustrating symptoms, but it might also cause some minor side effects. Not everyone will experience them, but according to information from the U.S. Food and Drug Administration (FDA), some common side effects include:

• Headache
• Nausea
• Increased appetite
• Trouble sleeping
• Weight gain
• Fatigue
• Fluid retention
• Acne

Prednisone may also cause certain serious side effects. While rare, these effects require immediate medical attention. 

• Allergic reaction
• High blood pressure
• Mood changes
• Severe stomach pain, vomiting, or red/black stools
• Seizures
• Fever and chills
• Muscle pain or weakness
• Bone pain
• Skin changes or growths
• Rapid weight gain or swelling in the hands, ankles, or feet
• Blurred vision
• Increased blood sugar

Other precautions

Prednisone may pose risks for people with certain conditions or on certain medications. For example, because it reduces immune resistance, it could make you more susceptible to infection. So, anyone taking it should avoid people who have highly infectious diseases like the flu or who recently received a live vaccine. 

Per Dr. Liebowitz, “Prednisone can increase blood sugar and must be used with caution in patients with diabetes. Over longer periods of time, more chronic prednisone can result in increased risk of weight gain, diabetes, osteoporosis, and infections, as well as symptoms such as insomnia and agitation.” 

Alcohol can exacerbate some of prednisone’s side effects and increase the risk of stomach bleeding, so it’s best to limit drinking while taking it. There is little evidence to suggest that it might harm unborn babies or breastfeeding newborns, but it’s still important to tell your doctor if you’re breastfeeding, pregnant, or planning on getting pregnant. 

MedlinePlus also recommends telling a doctor if you have eye infections, threadworms, myasthenia gravis, osteoporosis, seizures, tuberculosis, peptic ulcers, liver problems, chronic kidney disease, intestinal disease, heart disease, or heart issues. 

Drug interactions

The following are all medicines that might interact with prednisone. Tell your healthcare provider if you’re taking any of them. 

• NSAIDs such as aspirin, ibuprofen, or naproxen
• Diuretics
• Diabetes medications
• Estrogens (birth control pills or hormone replacement therapy)
• Blood thinners
• Macrolide antibiotics such as azithromycin
• Tuberculosis antibiotics
• Drugs that block cholinesterase (in people with myasthenia gravis)
• Aminoglutethimide, amphotericin B, cholestyramine, cyclosporine, digoxin, digitalis, and isoniazid

Frequently asked questions about prednisone and gout

Is prednisone better than ibuprofen for gout?

According to studies from 2008 and 2018, prednisone and non-steroidal anti-inflammatory drugs are equally effective treatment options for gout. However, corticosteroids like prednisone may have a more desirable safety profile for some adverse effects. “If someone has bad kidneys, high blood pressure, or is at high risk for heart attack and stroke, then the non-steroidal anti-inflammatories such as ibuprofen and naproxen are not going to be safe for that patient. That might be a patient we use prednisone for,” Dr. Downey says. 

Is colchicine or prednisone better for gout?

Colchicine is an alkaloid drug that’s FDA-approved to treat gout flare-ups, and like prednisone, it works by reducing inflammation. Research shows that it equates to prednisone’s efficacy in treating gout symptoms. In certain severe cases, a doctor might even prescribe them together. The two medications have different drug interactions and precautions, though, so the best option depends on your specific circumstances. 

Dexamethasone vs. prednisone for gout

Dexamethasone and prednisone are both corticosteroids, so they treat gout symptoms the same way. Although dexamethasone is more potent than prednisone, both are effective in treating the symptoms of gout. 

Allopurinol vs. prednisone for gout

The biggest difference between allopurinol and prednisone is that the former is proactive, while the latter is reactive. Allopurinol is a xanthine oxidase inhibitor that works by reducing the amount of uric acid in the body, helping prevent acute gout flares before they happen—and can also prevent kidney stones. Prednisone, on the other hand, alleviates an acute attack after it begins. Because they have different functions and don’t interact, some doctors may prescribe both medications together. 

How can someone prevent gout flares without medication?

Genetics is one of the primary risk factors for gout, and some cases simply require medication. However, we can control some of the risk factors and triggers, like dehydration, alcohol intake, and diet. “High fructose burden can lead to worse gouts,” Dr. Downey says. “So people with gout should avoid high fructose corn syrup, packaged foods, processed foods—anything that comes from a package.”