by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Corticosteroids can be given to those patients who cannot use NSAIDs or colchicine for gouty attacks.
Some rheumatologists recommend corticosteroids over NSAIDs as the preferred choice for treatment of acute gout. Steroids can be given orally, intravenously, intramuscularly, intra-articularly, or indirectly via adrenocorticotropic hormone (ACTH).
Prednisone can be given at a dose of approximately 40 mg for 1-3 days and then tapered over approximately 2 weeks. Tapering more rapidly can result in a rebound flare.
Using parenteral (intravenous or intramuscular) corticosteroids may be preferable in patients who cannot take oral medications.
Intra-articular (injected directly into a painful, swollen joint) corticosteroids are particularly useful in patients with a mono-articular flare (a single joint) to help reduce the systemic effect of oral steroids. This also offers the advantage of allowing joint fluid to be removed and examined for crystals or infection prior to injection of steroid. Ensuring that the joint is not infected prior to injecting intra-articular corticosteroids is particularly important.
ACTH at 40 IU IM can be given to induce corticosteroid production by the patient's own adrenal glands. This regimen does not depend on the patient to taper prednisone properly.
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