Is it safe to restart Prednisone?

Question

Hi doctor,

I was diagnosed with gout in left foot. It has been bothering me for a couple of weeks. Last month, I had issue with my elbow and took Prednisone. Recently, doctor said I cannot take Prednisone again so soon and was essentially struggling. Are there any other treatment options or drugs? How long should one have to wait until it is safe to take Prednisone again?

Answer 1

Hi,

Welcome to icliniq.com. No, there is no such restriction about restarting Prednisone. As long as there is a clinical need and we have exhausted other options then there is no contraindication to restart steroids. Surely, NSAIDS (non-steroidal anti-inflammatory drugs) should be tried before proceeding with the steroid. Also, local treatment with ice rest and use of local pain relieving gels can be and should be tried. Please respond with a clear formal diagnosis and let me know your history of current condition, underlying medical history, your treatment history, investigations done, allergies, smoking and alcohol. I will be more than happy to provide a clearer answer to help you with the management of your condition.

Answer 2

Hi,

Welcome back to icliniq.com. Thanks for providing with a more complete picture and attaching the images of your foot (attachment removed to protect patient identity) Gout can well be treated. NSAIDS like Diclofenac, Naproxen, etc., are the first line treatments for an acute attack such as you are having now. This along with elevation rest and icing the local will work well on most cases. For people who do not tolerate the NSAIDS or if response is inadequate then Colchicines orally is one of the other options. For best result, take within 12 hours of an acute attack. This has to be taken under supervision due to side effects. But in people who tolerate this, it is really effective. Looking at your ankle and foot pictures, the ideal thing to do would be to go for an ankle ultrasound to assess any fluid collection in the joint and have a steroid shot into the joint, which is safer due to less effect on the adrenocortical axis or hypothalamic-pituitary-adrenal axis (HPA axis), which incidentally your doctor was referring to. This is seen in patients who suddenly stop the steroids after being on them for over three weeks. Not so much about restarting them after a short period. Discuss this with your doctor and surely you can get relief without putting yourself at risk of a HPA crisis. My suggestion is go in a stepwise manner as I have suggested. Also try and lose some weight to avoid this situation from recurring.