Oral Corticosteroid for Acute Gouty Arthritis

• When selecting corticosteroids as the initial therapy, the TFP (Task Force Panel) recommended to first consider the number of joints with active arthritis. For involvement of 1 or 2 joints, the TFP recommended the use of oral corticosteroids (evidence B); the TFP additionally recommended the option of intraarticular corticosteroids for acute gout of 1 or 2 large joints (evidence B)
• For intraarticular corticosteroid therapy in acute gouty arthritis, it was recommended that dosing be based on the size of the involved joint(s), and that this modality could be used in combination (Table 1) with oral corticosteroids, NSAIDs, or colchicine (evidence B)
• Where intraarticular joint injection is impractical , the TFP recommended oral corticosteroids, prednisone, or prednisolone at a starting dosage of at least 0.5 mg/kg per day for 5–10 days, followed by discontinuation (evidence A) (28,43), or alternately, 2–5 days at the full dose, followed by tapering for 7–10 days, and then discontinuation (evidence C)
• no particular maximum doses indicated- depended on the nature and severity.

references:

1. www.uptodate.com

2. 2012 ACR Managemnet of Gout Part 2