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Gout

Sudden, very painful flares in a joint — often the big toe — caused by crystals of uric acid. Gout affects about 9 million U.S. adults. With the right diagnosis, medicine that lowers uric acid and steady daily habits, it is one of the most controllable kinds of arthritis.

Get medical care the same day — urgent care or an emergency department — for any of these:

Don’t wait for a chiropractic, acupuncture or massage appointment, and never have a hot, swollen joint massaged or manipulated.

What is gout?

Gout is a type of inflammatory arthritis that causes pain and swelling in the joints, usually as flares that last a week or two and then settle (NIAMS). It is the most common type of inflammatory arthritis (Arthritis Foundation).

It starts with uric acid (urate), a waste product your body makes when it breaks down purines from its own tissues and from many foods. The kidneys normally filter it out into the urine; if your body makes too much or removes too little, it builds up in the blood (MedlinePlus). Over time, high levels can form needle-shaped crystals in and around a joint, causing inflammation — though many people with high uric acid never get gout (NIAMS).

How common is it?

In a national U.S. health survey for 2015–2016, 3.9% of U.S. adults — about 9.2 million people — had gout: 5.2% of men and 2.7% of women. Only about a third of people with gout were taking medicine to lower uric acid (Chen-Xu et al., 2019).

Sudden, painful flares

Many people have their first flare in a big toe. Flares often start suddenly at night, with pain bad enough to wake you, and the joint may be swollen, red and warm (NIAMS). Gout can also strike other toes, the ankle or the knee (MedlinePlus), usually one joint at a time (CDC). Attacks usually peak after 12 to 24 hours (Arthritis Foundation). Between flares you usually feel fine, but untreated flares may come more often and last longer. Foods, alcohol, some medicines, injury or illness can set them off (NIAMS). See our feet guide for other causes of foot pain.

Who gets gout?

Tophi and kidney stones

Untreated for years, crystals can build into hard lumps called tophi under the skin and in and around joints. They start painless but can become painful and damage bone and joints; proper treatment can prevent them (NIAMS). They often sit over a joint or on the outer ear (ACR). Uric acid crystals can also form kidney stones, and uric acid–lowering medicine helps prevent both (MedlinePlus).

Links with heart and kidney disease

People with gout are more likely to have high blood pressure, chronic kidney disease, obesity, diabetes, kidney stones, heart attack and heart failure (NIAMS), so your provider may check for these (ACR). High uric acid can also lead to kidney failure (MedlinePlus). See our blood pressure and diabetes guides; MBHA guides to the kidneys and the heart are on the way.

How it’s diagnosed

Red, hot, swollen skin can also be an infection called cellulitis (NHS) — see our cellulitis guide. Most people with gout are cared for by their primary care provider (NIAMS).

Pseudogout (CPPD) is different

Calcium pyrophosphate deposition (CPPD), once called “pseudogout,” comes from calcium pyrophosphate crystals, not uric acid. It causes severe pain, warmth and swelling, most often in the knees, and is more common after 60; there is no treatment yet that dissolves its crystals (ACR). See our arthritis guide for other types.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) NSAIDs, colchicine or corticosteroids for flares; for frequent flares, tophi or kidney stones, daily urate-lowering medicine — allopurinol first — adjusted to a uric acid target, with preventive medicine at the start. Cost estimate being researched. Flare medicine should start working within 2 days. Taken steadily, urate-lowering medicine prevents flares and tophi; many people become flare-free.
Chiropractic No role in treating gout or its flares. Never have an inflamed joint manipulated. Not applicable to gout care. We found little research on chiropractic care for gout.
Acupuncture Needle or electroacupuncture sessions, studied mainly for acute flares. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Reviews of mostly small trials from China report benefits, but the evidence is low or very low quality. Not a substitute for medicine.
Herbal medicine Cherries or cherry extract, vitamin C and coffee are the most studied; celery seed is widely promoted. Cost estimate being researched. Mostly observational or weak evidence; the ACR guideline advises against adding vitamin C. No supplement replaces urate-lowering medicine.
Massage therapy Gentle massage of other areas for comfort — never on a flaring joint. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. A comfort measure only; we found little research on massage for gout.
MBHA Wellness Coach Food and drink changes, weight loss, fluids, taking medicine every day, a flare plan, flare footwear, and tracking blood pressure and kidney health. Cost estimate being researched. Supports — never replaces — medical care. Habits help, but medicine is the mainstay when flares are frequent or tophi are present.

Approach 1 of 6

Conventional medicine (AMA)

Treatment has two jobs: calm each flare quickly, and lower uric acid over the long term so flares, tophi and joint damage stop (NIAMS). U.S. care follows the 2020 American College of Rheumatology (ACR) guideline (ACR guideline, 2020).

1. Treating a flare

The guideline strongly recommends colchicine, NSAIDs (anti-inflammatory pain relievers) or corticosteroids (by mouth or by injection), chosen to suit the person; an IL-1 blocker is an option if these can’t be used (ACR guideline, 2020). Colchicine works best when taken as symptoms first appear (NIAMS). NSAIDs can cause stomach ulcers and bleeding, and colchicine can cause nausea or diarrhea (Arthritis Foundation).

2. Who needs urate-lowering therapy (ULT)?

The guideline strongly recommends daily ULT for people with tophi, joint damage from gout on imaging, or frequent flares (two or more a year). It conditionally recommends it for less frequent flares, and after a first flare in people with moderate or worse kidney disease, very high uric acid or kidney stones (ACR guideline, 2020).

3. The medicines

4. Treat to target, with protection at the start

We don’t list doses; your doctor will tailor any medicine to you.

5. Your other medicines

Where practical, the guideline suggests switching from the diuretic hydrochlorothiazide to another blood pressure medicine, but not stopping low-dose aspirin taken for a good reason (ACR guideline, 2020). Talk with your doctor before changing any medicine (NIAMS); see our blood pressure guide.

What it costs

Gout medicines and tests: MBHA cost estimate being researched.

What to expect

With early diagnosis, treatment and lifestyle changes, gout is one of the most controllable forms of arthritis, and some people become gout-free (NIAMS). With frequent flares or tophi, taking ULT regularly is the key (NIAMS).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating gout or a gout flare; the proven treatments are medicines (ACR guideline, 2020). We found little research on chiropractic care for gout — mainly a review urging chiropractors to recognize the uncommon cases where gout affects the spine (McConville and Cox, 2023).

MBHA caution: never have a hot, swollen or flaring joint manipulated or pressed. Pressure can make the pain worse (NHS), and the joint may be infected (see the alert above). Serious problems after spinal manipulation are very rare but may be more likely with underlying health problems (NCCIH).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied for gout flares, mostly in small trials in China, alone or added to standard medicine. The reviews sound positive, but the trials are generally low quality.

Acupuncture may add comfort, but it hasn’t been shown to replace flare medicine or the long-term work of lowering uric acid.

Safety and cost

Few complications have been reported; problems have come from non-sterile needles and poor technique, and U.S. needles must be sterile and single-use (NCCIH). MBHA suggests ruling out a joint infection first and keeping needles out of a hot, swollen joint. Visits run about $125–$230 for a first private visit and $90–$185 for follow-ups, or about $50–$90 at community clinics (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No food or supplement replaces urate-lowering medicine. A 2025 review of trials of cherry products, vitamin C, fish oil and Chinese herbal formulas found mixed, often contradictory results (Pardali et al., 2025), and a Cochrane review found no high-quality evidence for or against the supplements it assessed (Cochrane review, 2021).

Before you take any supplement, show it to your doctor or pharmacist: supplements may interact with your medicines or pose risks with some health problems (NCCIH). Never swap a gout medicine for a supplement. We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage doesn’t treat gout, and we found little research on it. Don’t massage a flaring joint: pressure can make the pain worse (NHS), and a hot, swollen joint could be infected. Gentle massage elsewhere — back, neck or shoulders — may help you relax while you recover; tell your therapist you have gout. Don’t use massage to put off seeing a provider; rare serious side effects have been reported (NCCIH).

What it costs

About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach helps you turn your care plan into daily habits — alongside, never instead of, medical care. Genes play a big part in gout, and the ACR guideline’s authors caution that diet advice should never feel like blame (ACR guideline, 2020).

Food and drink

The guideline conditionally recommends limiting alcohol, purine-rich foods and high-fructose corn syrup (ACR guideline, 2020). Your coach can help you find swaps you’ll keep (see Food and drink).

Weight, activity and fluids

For people with overweight, the guideline suggests weight loss (ACR guideline, 2020), which helps reduce uric acid and flares (NIAMS); avoid crash diets (NHS). Aim for 150 minutes a week of moderate activity (CDC). Drink plenty of fluids (NHS) — water also helps prevent kidney stones (NIDDK) — unless you have kidney failure or are on dialysis and your team limits fluids (see our dialysis guide). An MBHA weight control guide is on the way.

Taking medicine every day

Taking ULT regularly is the key to preventing flares (NIAMS), even when you feel well (NHS). A coach can help with reminders, refills and a log of your uric acid results.

A flare action plan

Plan ahead with your doctor. The guideline’s patient panel favored keeping flare medicine on hand for the first signs (ACR guideline, 2020), since flare medicines work best when started early (Arthritis UK). Write down what to take, the steps in During a flare, who to call and the warning signs at the top of this page.

Footwear during flares

Keep pressure and bedclothes off the sore joint (NHS). MBHA suggests soft, roomy shoes or open-toed sandals that don’t press on the big toe while it flares.

Blood pressure and kidney health

Because gout travels with high blood pressure, heart and kidney disease (ACR), keep up with blood pressure and kidney checks. The DASH eating plan can help lower blood pressure and may lower uric acid (NIAMS); see our blood pressure and diabetes guides.

Another approach

During a flare: what helps

First check the alert at the top of this page. Then:

An untreated attack usually lasts 1 to 2 weeks. See a doctor if your usual treatment isn’t helping (NHS).

Another approach

Long-term: lowering uric acid

Flare medicines calm the fire; urate-lowering medicine removes the fuel, stopping new crystals and dissolving old ones. Clearing them can take months or years, but once they’re gone, attacks and tophi stop (Arthritis UK). Know your number — the goal is below 6 mg/dL (ACR guideline, 2020) — expect a bumpy first few months, and plan to stay on treatment (see conventional medicine).

Another approach

Food and drink

Diet usually changes uric acid only a little, but food and drink may trigger flares (ACR guideline, 2020).

A Mediterranean or DASH-style diet may help prevent attacks and is good for the heart (Arthritis Foundation). Talk with your doctor before changing your diet or medicines (NIAMS).

Member stories

Living with Gout? Share your experience

Real experiences help others choose. Tell us what you tried — conventional medicine, chiropractic, acupuncture, herbs, massage or coaching — what it cost and what changed.

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Which approaches have you tried?

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)(3) organization and does not endorse any particular products or practices. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. We strongly recommend that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition. MBHA provides administrative support, education and navigation — not medical, legal or tax advice — and cannot guarantee claim, billing or fundraising outcomes. MBHA is not an emergency service: in an emergency, call 911 or go to the nearest emergency room.