Gout

The Cochrane review of anti-inflammatory drugs for acute gout describes gout as an inflammatory arthritis caused by crystals of monosodium urate deposited in and around joints. A flare, which the trials call acute gouty arthritis, is an attack of joint pain and swelling. The acupuncture trials for gout almost all treat flares, and almost all compare needling, alone or added to drugs, with the drugs alone; none of the six reviews below included a trial against sham acupuncture, a control procedure built to resemble it. The trials measure pain on a 10-point scale, serum uric acid, and a response rate: the share of patients the trial authors classed as improved.

No Cochrane review

Cochrane has published no review of acupuncture for gout. Its gout reviews cover drugs. The 2021 NSAID review cited above by van Durme and colleagues, searched to August 2020, included 28 trials with 3,406 participants, and one of them, with 163 participants, compared acupuncture plus infrared irradiation with an NSAID, a non-steroidal anti-inflammatory drug. The review rated the evidence from that single trial low certainty and found it insufficient for firm conclusions. The 2021 Cochrane review of colchicine by McKenzie and colleagues found four trials with 803 participants and low-quality evidence that low-dose colchicine improves a flare compared with placebo, with benefits that may be similar to NSAIDs.

Systematic reviews

A 2013 concise report by Lee and colleagues at Kyung Hee University in Seoul, searched English and Chinese databases and found 10 trials in which acupuncture was added to conventional treatment. Six trials with 512 patients reported a significant fall in uric acid with acupuncture and two with 120 patients reported none; four with 380 patients reported lower pain scores. The authors asked for larger, rigorous trials.

A 2016 update by Lu and colleagues at Tongji Hospital in Wuhan found 28 trials, all run by Chinese investigators at a single centre and published between 2002 and 2015. Against drugs such as colchicine, indomethacin and allopurinol, it reported more patients free of symptoms at 24 hours, lower uric acid, less pain and fewer adverse events with acupuncture, and no difference in C-reactive protein, a blood marker of inflammation. The authors wrote that the benefit might be overstated because of the trials' methodological weaknesses: every control group took drugs, so no participant could be blinded, and they named sham acupuncture as the preferable control.

Two reviews covered methods other than plain needling. Li and colleagues pooled 12 bloodletting trials, in which points are pricked to release a few drops of blood, and reported pain 1.13 points lower on a 10-point scale, lower C-reactive protein and fewer adverse reactions than with standard drugs, while uric acid fell by a similar amount in both groups. Bloodletting describes the method. Hwang, Song and Song at Gachon University in Korea pooled 13 trials of fire needling, a heated needle inserted briefly, and warm needling, in which burning mugwort heats the needle handle. All 13 were conducted in China, and the authors counted that regional bias, with the high or unclear risk of bias in most trials, as the reason more trials are needed. The trials most often needled the tender spot itself, an ashi point, and then SP06 (Sanyinjiao), SP09 (Yinlingquan) and ST36 (Zusanli). Fire needling covers the technique.

The 2023 electroacupuncture review by Ni and colleagues at Chengdu University of Traditional Chinese Medicine rated its evidence with GRADE. Against drugs it reported pain 2.26 points lower and uric acid 31.6 µmol/L lower with electroacupuncture, and fewer adverse events in the five trials that reported them (risk ratio 0.20). All 15 trials were run in China, none was multicentre, and only one blinded the people measuring outcomes. Its own table rates the uric acid result moderate certainty and the pain result very low. SP06 and ST36 were the points stimulated most often.

A 2024 network meta-analysis by Fan and colleagues, which compares many treatments at once through shared comparators, ranked acupoint application, a Chinese herbal paste applied to the skin over points, first for pain, response rate and uric acid. All its trials were open to participants and staff, and two of 32 blinded the outcome assessors. The authors called the evidence poor because the trials were of low quality.

Reviews of the reviews

A 2025 overview by Zuo and colleagues, in Chinese with an English abstract, assessed nine systematic reviews of bloodletting for gout, covering 70 trials and 3,937 patients. Every review reported benefit. Graded with GRADE, all 45 outcomes rested on low or very low quality evidence, and on AMSTAR 2, a checklist for the quality of a review, the reviews had deficiencies in five critical items. The same trials appeared in several reviews, so their agreement is partly one set of trials counted more than once. A 2025 GRADE assessment of electroacupuncture by Zhu and colleagues rated electroacupuncture alone low quality for uric acid and pain, and electroacupuncture with drugs moderate quality for uric acid and two inflammation markers.

Trials

Recent trials test how fast needling eases a flare. At Longhua Hospital in Shanghai, Liu and colleagues randomised 90 people in a flare to 50 mg of diclofenac, 100 mg of diclofenac, or 50 mg with one session of electroacupuncture at the tender points and points including SP06, ST36, SP09 and LV03 (Taichong). Ten minutes after treatment pain was lower with electroacupuncture than in either drug group, and over six hours lower than with the 50 mg dose alone; extra diclofenac was needed by 1 of 30 in the combined group, 1 of 29 on the full dose and 5 of 28 on the half dose. The trial notation writes the liver point LR 3; Reading a point code explains the difference.

A 2026 trial by Lin and colleagues, posted as a preprint that has not been peer reviewed, compared one session of cheek acupuncture with oral etoricoxib in 76 people and reported lower pain at two hours with acupuncture. Two registered trials in China use sham controls. A multicentre trial, approved by the ethics committee of Beijing University of Chinese Medicine, planned to give 160 people in a flare etoricoxib and then real or sham acupuncture, with pain 30 minutes later as the main outcome. A second trial, at three hospitals, planned 16 sessions of real or sham acupuncture over eight weeks for 180 people with high uric acid but no gout, measuring uric acid. Neither had published results by October 2026. Sham acupuncture sets out what such a control does and does not rule out.

What guidelines say

The American College of Rheumatology's 2020 guideline for the management of gout, by FitzGerald and colleagues, does not mention acupuncture. For a flare it strongly recommends colchicine, an NSAID or a glucocorticoid by mouth or injection, and conditionally recommends topical ice as an addition. The ACR's guideline page lists the 2020 version as its latest, with no newer project.

The 2016 EULAR recommendations, by Richette and colleagues for the European League Against Rheumatism (EULAR) and published in 2017, do not mention acupuncture either. They recommend treating a flare as early as possible with colchicine within 12 hours of onset, an NSAID, an oral corticosteroid, or aspiration and corticosteroid injection of the joint, and combinations for severe flares. EULAR's list of its recommendations still gives the 2016 update for management.

NICE's guideline NG219, published in June 2022, makes the same first-line choice of an NSAID, colchicine or a short course of oral corticosteroid, advises that ice packs alongside medicine may help, and does not mention acupuncture. The Chinese Society of Endocrinology's 2024 update of its gout guideline, published in 2025, does not mention it. Clinical guidelines compares how guideline bodies treat acupuncture across conditions.

What the reviews could not settle

None of the reviews included a sham-controlled trial, and the two registered ones have not reported, so the reviews cannot separate the needling from the attention and expectation that come with it, and pain, the outcome most trials report, is the one participants rate themselves. The trials pooled were run in China, mostly at single centres. Lu 2016 noted that some of its trials stopped urate-lowering drugs during the flare, which the guidelines it cited advise continuing, and that this could exaggerate the conclusions; Ni 2023 found that some of its trials did not report urate-lowering treatment at all. The only results rated moderate certainty are laboratory measures, uric acid and markers of inflammation, and none of the reviews reported whether fewer flares followed. Where the trials come from sets out what the share of positive results by country shows across acupuncture research.

AcuiQ's gout page lists the protocols individual studies prescribed, each with its citation.