Cold therapy for gout (acute gouty arthritis)
Evidence review
Overview
Cold applied locally to an inflamed gouty joint has been tested in two randomized trials. In 19 patients with acute gout on prednisone and colchicine, adding topical ice produced greater pain reduction over one week. A community randomized trial in 76 Indonesian adults with gout reported reduced pain and improved joint mobility, stress, anxiety and quality of life after 4 weeks of daily 20-minute cold-water immersion at 68-86 F. Neither trial used whole-body cold immersion, and the immersion trial's water temperature is cool rather than cold.
Key findings
- RCT, 19 acute gout patients: pain reduction 7.75 +/- 2.58 cm with ice vs 4.42 +/- 2.96 cm without (10 cm VAS, p=0.021), both on prednisone and colchicine (Schlesinger 2002).
- Community RCT, 76 adults with gout: daily 20-min immersion at 68-86 F for 4 weeks reduced pain (beta -2.06) and improved joint mobility and quality of life vs control at 2 and 4 weeks (Kurniasari 2022).
Every study we reviewed
2 found benefit
Each study was checked on PubMed. The colored edge shows the direction of the result.
Local ice therapy during bouts of acute gouty arthritis.
Schlesinger N et al. J Rheumatol. 2002. PubMed 11838852
- Who
- patients with acute gouty arthritis
- What
- topical ice therapy to the affected joint added to oral prednisone (30 mg tapered over 6 days) and colchicine 0.6 mg/day, vs same drugs without ice
- Protocol
- 1 wk
- Measured
- pain VAS, joint circumference, synovial fluid volume
- Result
- Mean pain reduction 7.75 cm (SD 2.58) with ice vs 4.42 cm (SD 2.96) control (p=0.021); joint circumference and synovial fluid volume trended lower but not significant.
- Limitations
- very small; local ice not whole-body; 1-week follow-up
Cold Water Immersion Directly and Mediated by Alleviated Pain to Promote Quality of Life in Indonesian with Gout Arthritis: A Community-based Randomized Controlled Trial.
Kurniasari MD et al. Biol Res Nurs. 2022. PubMed 35021915 · DOI
- Who
- community adults with gout arthritis in Tomohon, Indonesia
- What
- cold-water immersion (site not specified in abstract) vs control
- Protocol
- 68-86 °F · 20 min · 7/wk · 4 wk
- Measured
- pain, joint mobility, physical activity, stress, anxiety, depression, quality of life
- Result
- Significant pain alleviation (beta -2.06) and improved joint mobility (beta 1.20), stress (beta -1.25), anxiety (beta -0.62) and quality of life (beta 5.34) at week 2, maintained at week 4 vs pre-intervention and control; depression decreased by week 4 (beta -1.80).
- Limitations
- single community trial; blinding not described; water temperature well above typical cold-plunge range; immersion site not stated in abstract
Protocols used in the studies
Topical ice to the inflamed joint during a one-week flare alongside standard drug therapy; or daily 20-minute immersion in 68-86 F water for 4 weeks. No whole-body cold immersion protocol has been studied in gout.
What is still unknown
Whether whole-body cold immersion adds anything beyond local joint cooling; optimal temperature and duration; effect on flare duration and recurrence.
Safety
Cautions for cold therapy in this condition
- Cold is an adjunct; both trials kept or allowed standard anti-inflammatory treatment (Schlesinger 2002, PMID 11838852).
- Gout commonly coexists with hypertension, cardiovascular and kidney disease; whole-body cold immersion raises blood pressure acutely (Radtke 2016, PMID 26152773). See general cold safety entry.
For clinicians
Suggested rationale
Local cold is a reasonable adjunct for acute gout pain: adding topical ice to standard therapy produced greater pain reduction in a small RCT (Schlesinger 2002), and daily cool-water immersion improved pain and quality of life in a community RCT (Kurniasari 2022). Whole-body cold plunge has not been studied in gout.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: M10.9, M10.07. Examples only; the clinician assigns the code.
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