Research Confirms Cold Therapy Benefits During Gout Flares

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New research has found that cold fomentation was more effective than hot fomentation in relieving pain and improving mobility in patients with a gout flare, while hot fomentation often worsened symptoms.¹

“Heat therapy, such as hot saline fomentation, can exacerbate the inflammatory response during a gout attack by increasing blood flow to the affected area, leading to further swelling and discomfort. Heat may also contribute to the solubilization of uric acid crystals, potentially promoting their deposition in joints, thereby worsening symptoms during the acute phase of gout,” Shivam Mehra, Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India, and colleagues wrote.¹

Mehra and colleagues conducted a randomized controlled trial including 2,400 patients with gout randomized to receive hot fomentation (38°C–42°C) or cold fomentation (5°C–10°C) applied twice daily for 20 minutes over 5 days, alongside standard care. They measured pain intensity using the visual analog scale (VAS), while joint circumference, range of motion, and patient satisfaction were recorded at baseline, day 3, and day 5, and used statistical analysis to compare outcomes between the 2 groups.¹

The investigators found that cold fomentation significantly reduced pain intensity on VAS by 68% by day 5 compared to hot fomentation, which yielded a 26% reduction on VAS (P <.001). The cold group also experienced a decrease in joint swelling by 25% versus 5% in the hot group and had greater improvements in joint mobility (average increase of 15° vs. 5°, P <.01). Notably, 35% of the hot group experienced flare-ups, compared to only 2% in the cold group (P <.001). The cold group had a higher rate of satisfaction (85%) than the hot group (30%).¹

“These results strongly suggest that cold fomentation should be the preferred thermal therapy in the management of gout flares, while hot fomentation should be avoided due to the risk of worsening the inflammatory response. Clinicians should consider these findings when advising patients on appropriate thermal therapies for gout management,” Mehra and colleagues concluded.¹

In other relevant news related to gout management, recent research found that while rheumatologists self-report high adherence to the 2020 American College of Rheumatology (ACR) Guideline for Gout Management, there are gaps in knowledge and adherence, particularly around dosing of treatment regimens.²

The mean overall stated adherence score was 11.5 (maximum 15), and the mean overall stated agreement score was 7.7 (maximum 14). Schlesinger and colleagues found that less experienced rheumatologists with up to 8 years of experience (n = 49) were more likely to report adherence (mean stated adherence score, 12.3) to individual ACR recommendations than those with more experience (n = 152; mean stated adherence score, 11.3; P ≤.05).²

Guidelines for initiating urate-lowering therapy (ULT) were reportedly followed by 78% of rheumatologists, with 89% likely to prescribe allopurinol as a first-line ULT. Dosing recommendations were not highly adhered to, with 43% adhering to febuxostat dosing recommendations and 39% adhering to allopurinol dosing recommendations. Furthermore, rheumatologists from academic settings were more likely to prescribe an interleukin-1 inhibitor for gout flares.²

These findings are notable as proper ULT administration has been shown to improve outcomes in people with gout in multiple ways.

REFERENCES

1. Mehra S, Mehra K, Mehra NK, Kale SY, Manchanda BV. Data Insights on the Risks of Local Heat and Massage in Gouty Arthritis Treatment. J Orthop Case Rep. 2025;15(1):260-265. doi:10.13107/jocr.2025.v15.i01.5194

2. Schlesinger N, Pillinger MH, Lipsky PE. Knowledge of and Stated Adherence to the 2020 American College of Rheumatology Guideline for Gout Management: Results of a Survey of US Rheumatologists. J Rheumatol. 2025, 52 (1) 77-86; doi: 10.3899/jrheum.2023-0981