John is a 40-year-old man who works as a construction worker. He has no significant past medical history and takes no regular medications. He presents to his GP with severe pain and swelling in his right big toe, which started two days ago. He says he has never had this before and denies any trauma or injury to the foot. He has tried taking ibuprofen and paracetamol, but they did not help much.
His right big toe is red, hot, swollen, and tender on examination. He has a temperature of 37°C and a pulse of 87 beats per minute. His blood pressure is 140/90 mmHg, and his BMI is 28 kg/m2. Bloods done 1 month ago show normal renal function and liver function.
The GP suspects that John has acute gout and prescribes him 40 mg of prednisolone daily for 10 days, along with colchicine 0.5 mg twice daily for three days. He advises John to drink plenty of fluids, avoid alcohol and purine-rich foods, and rest the affected joint. He also arranges a follow-up appointment in two weeks.
Questions:
What are the potential complications of long-term steroid use?
How long can John safely take prednisolone without needing to taper down the dose?
What are the indications for starting allopurinol in patients with gout?
How would you monitor John’s response to treatment and adjust his medication regimen accordingly?