---
title: "Gout"
url: "https://acuiq.com/wiki/evidence/gout"
updated: 2026-10-14
last_verified: 2026-10-14
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-14"
reading_minutes: 10
sources: 20
---

# Gout

_What systematic reviews, an overview, trials and the ACR, EULAR and NICE guidelines report on acupuncture, electroacupuncture, bloodletting and fire needling for gout._

The [Cochrane review of anti-inflammatory drugs for acute gout](https://doi.org/10.1002/14651858.CD010120.pub3) 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](https://doi.org/10.1002/14651858.CD006190.pub3) 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

| Review | Searched to | Trials (people) | Method and comparison | Certainty |
| --- | --- | --- | --- | --- |
| Lee 2013 | August 2012 | 10 (852) | Acupuncture added to conventional drugs, against the drugs alone | Not graded |
| Lu 2016 | October 2015 | 28 (2,237) | Manual or electroacupuncture, alone or with drugs or herbs, against drugs | Not graded |
| Li 2022 | July 2020 | 12 (894) | Bloodletting against standard drugs | Not graded |
| Hwang 2022 | December 2020 | 13 (840) | Fire or warm needling, alone or combined, against standard drugs | Most trials at high or unclear risk of bias |
| Ni 2023 | July 2023 | 15 (1,076) | Electroacupuncture, alone or with drugs, against drugs | GRADE moderate for uric acid, low for response rate and adverse events, very low for pain |
| Fan 2024 | May 2022 | 32 (2,434) | Network comparison of several acupuncture-related methods and drugs | Evidence described as poor |

A [2013 concise report](https://doi.org/10.1093/rheumatology/ket013) 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](https://doi.org/10.1155/2016/9451670) 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](https://doi.org/10.1016/j.ctcp.2021.101503) 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](/wiki/techniques/bloodletting) describes the method. [Hwang, Song and Song](https://pmc.ncbi.nlm.nih.gov/articles/PMC9806158/) 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`](/points/sp06) (Sanyinjiao), [`SP09`](/points/sp09) (Yinlingquan) and [`ST36`](/points/st36) (Zusanli). [Fire needling](/wiki/techniques/fire-needling) covers the technique.

The [2023 electroacupuncture review](https://doi.org/10.3389/fimmu.2023.1295154) 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](https://doi.org/10.1016/j.heliyon.2024.e28122) 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](https://doi.org/10.19540/j.cnki.cjcmm.20250916.501) 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](https://doi.org/10.12200/j.issn.1003-0034.20250654) 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](https://doi.org/10.13703/j.0255-2930.20220907-k0001) 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`](/points/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](/wiki/nomenclature/point-codes) explains the difference.

A [2026 trial](https://doi.org/10.21203/rs.3.rs-10992806/v1) 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](https://doi.org/10.2147/jpr.s523657), 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](https://doi.org/10.3389/fendo.2023.1218546), 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](/wiki/research/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](https://doi.org/10.1002/acr.24180), 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](https://rheumatology.org/gout-guideline) lists the 2020 version as its latest, with no newer project.

The [2016 EULAR recommendations](https://doi.org/10.1136/annrheumdis-2016-209707), 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](https://www.eular.org/recommendations-management) still gives the 2016 update for management.

NICE's guideline [NG219](https://www.nice.org.uk/guidance/ng219/chapter/Recommendations), 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](https://doi.org/10.1111/1756-185x.70375), published in 2025, does not mention it. [Clinical guidelines](/wiki/evidence/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](/wiki/research/where-the-trials-come-from) sets out what the share of positive results by country shows across acupuncture research.

AcuiQ's [gout page](/symptoms/gout) lists the protocols individual studies prescribed, each with its citation.

### Sources

1. van Durme CM, Wechalekar MD, Landewé RB, et al., Non-steroidal anti-inflammatory drugs for acute gout, Cochrane Database of Systematic Reviews 2021, CD010120.pub3 — https://doi.org/10.1002/14651858.CD010120.pub3
2. McKenzie BJ, Wechalekar MD, Johnston RV, Schlesinger N, Buchbinder R, Colchicine for acute gout, Cochrane Database of Systematic Reviews 2021, CD006190.pub3 — https://doi.org/10.1002/14651858.CD006190.pub3
3. Lee WB, Woo SH, Min BI, Cho SH, Acupuncture for gouty arthritis: a concise report of a systematic and meta-analysis approach, Rheumatology 2013 — https://doi.org/10.1093/rheumatology/ket013
4. Lu WW, Zhang JM, Lv ZT, Chen AM, Update on the clinical effect of acupuncture therapy in patients with gouty arthritis: systematic review and meta-analysis, Evidence-Based Complementary and Alternative Medicine 2016 — https://doi.org/10.1155/2016/9451670
5. Li SH, Hu WS, Wu QF, Sun JG, The efficacy of bloodletting therapy in patients with acute gouty arthritis: a systematic review and meta-analysis, Complementary Therapies in Clinical Practice 2022 — https://doi.org/10.1016/j.ctcp.2021.101503
6. Hwang JH, Song A, Song HS, Systematic review and meta-analysis of efficacy and safety of fire needling and warm needling on acute gout, Journal of Pharmacopuncture 2022 — https://pmc.ncbi.nlm.nih.gov/articles/PMC9806158/
7. Ni Z, Xiao Q, Xia Z, Kuang K, Yin B, Peng D, Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials, Frontiers in Immunology 2023 — https://doi.org/10.3389/fimmu.2023.1295154
8. Fan Y, Zhu C, Ji Y, Peng J, Wang G, Wan R, Liu W, Comparison of efficacy of acupuncture-related therapies in treating acute gouty arthritis: a network meta-analysis of randomized controlled trials, Heliyon 2024 — https://doi.org/10.1016/j.heliyon.2024.e28122
9. Zuo JX, Shi LJ, Zhang YJ, et al., Overview of systematic reviews on efficacy and safety of puncture and bloodletting therapy for gout (in Chinese), China Journal of Chinese Materia Medica 2025 — https://doi.org/10.19540/j.cnki.cjcmm.20250916.501
10. Zhu K, Wei GC, Zhang XW, et al., Evidence evaluation of electroacupuncture treatment for gouty arthritis based on GRADE and integrated evidence chain-based efficacy evaluation of traditional Chinese medicine (in Chinese), China Journal of Orthopaedics and Traumatology 2025 — https://doi.org/10.12200/j.issn.1003-0034.20250654
11. Liu LM, Yin P, Hu JW, Chen YL, Immediate analgesic effect of electroacupuncture combined with diclofenac sodium on acute gouty arthritis: a randomized controlled trial (in Chinese), Chinese Acupuncture and Moxibustion 2023 — https://doi.org/10.13703/j.0255-2930.20220907-k0001
12. Lin Y, Yang Z, Luo Y, Liu Q, Sun L, Fan G, Immediate analgesic effect of cheek acupuncture vs etoricoxib for patients with acute gouty flare: a randomized controlled trial (preprint), Research Square 2026 — https://doi.org/10.21203/rs.3.rs-10992806/v1
13. Wang YR, Liu CZ, Cong Y, et al., Acupuncture as an adjunctive therapy to etoricoxib for patients with acute gouty arthritis: protocol for a multicenter randomized controlled trial, Journal of Pain Research 2025 — https://doi.org/10.2147/jpr.s523657
14. Yu LL, Li CN, Fang MY, et al., Evaluating the effectiveness and safety of acupuncture on serum uric acid in asymptomatic hyperuricemia population: a randomized controlled clinical trial study protocol, Frontiers in Endocrinology 2023 — https://doi.org/10.3389/fendo.2023.1218546
15. FitzGerald JD, Dalbeth N, Mikuls T, et al., 2020 American College of Rheumatology guideline for the management of gout, Arthritis Care and Research 2020 — https://doi.org/10.1002/acr.24180
16. American College of Rheumatology, Gout guideline (guideline status page) — https://rheumatology.org/gout-guideline
17. Richette P, Doherty M, Pascual E, et al., 2016 updated EULAR evidence-based recommendations for the management of gout, Annals of the Rheumatic Diseases 2017 — https://doi.org/10.1136/annrheumdis-2016-209707
18. National Institute for Health and Care Excellence, Gout: diagnosis and management (NG219), 2022 — https://www.nice.org.uk/guidance/ng219/chapter/Recommendations
19. EULAR, Recommendations: management (list of current EULAR recommendations) — https://www.eular.org/recommendations-management
20. Sun M, Lyu Z, Wang C, et al., 2024 update of Chinese guidelines for diagnosis and treatment of hyperuricemia and gout part I: recommendations for general patients, International Journal of Rheumatic Diseases 2025 — https://doi.org/10.1111/1756-185x.70375