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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 get better (MedlinePlus). It is the most common type of inflammatory arthritis (Arthritis UK).

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 pain and swelling (MedlinePlus) — though not everyone with high uric acid develops gout (CDC).

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

Flares often begin in the big toe. They often start suddenly at night, with pain bad enough to wake you, and the joint may be swollen, red and warm (MedlinePlus). Gout can also strike other toes, the ankle or the knee (MedlinePlus), usually one joint at a time (CDC). Symptoms usually feel worst within the first 12 to 24 hours (Arthritis UK). Between flares you usually have no symptoms, but untreated flares may come more often and last longer (MedlinePlus). A knock to the joint, an illness with fever, surgery, a very large meal, too much alcohol or dehydration can set one off (Arthritis UK). See our feet guide for other causes of foot pain.

Who gets gout?

Tophi and kidney stones

Untreated for years, gout can build hard lumps of uric acid called tophi under the skin. They start painless but can become painful and damage bone, soft tissue and joints (MedlinePlus); medicine that lowers uric acid helps prevent them (CDC). 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

Gout is often linked with high blood pressure, heart disease and kidney disease, so your provider may check for these (ACR). It is more common in people with heart failure, high blood pressure, insulin resistance, diabetes or poor kidney function (CDC). Years of high urate can narrow the arteries, raising the risk of stroke and heart attack, and raise the risk of kidney disease (Arthritis UK). 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. Your primary care provider is usually the first stop, and may refer you to a rheumatologist if the diagnosis is still unclear (NHS).

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. The usual gout medicines are cheap generics: as of Oct. 28, 2026, pharmacies paid on average about $0.03–$0.05 per allopurinol tablet, about $0.12 per colchicine tablet and about $0.05–$0.06 per standard naproxen tablet (Medicaid NADAC survey; what you pay at the counter is higher and varies). Medicare Part B usually charges nothing for covered diagnostic lab tests and, after the deductible, 20% of the Medicare-approved amount for most doctor services, and Part D out-of-pocket costs are capped at $2,100 in 2026. As of Nov. 4, 2026, pharmacies also paid on average about $0.19–$0.25 per febuxostat tablet and about $0.04–$0.17 per plain prednisone tablet, depending on tablet size (Medicaid NADAC survey; counter prices are higher). Other costs: 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. We found no price range we can cite for herbal consultations or herbal products, so we give none. These are usually paid out of pocket, and prices vary widely by practitioner and product. NCCIH suggests asking your insurer whether an approach is covered (and whether it needs a referral or an in-network practitioner), asking the practitioner what the first and follow-up visits cost and whether there is a sliding scale, and asking what other costs apply, such as tests and supplements; health savings or flexible spending accounts may help with some costs. 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. At one national chain, about $125–$160 for a 60-minute massage without a membership; memberships about $70–$90 a month. 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. Included with a paid MBHA membership: a monthly wellness coaching email from a certified Holistic Health & Lifestyle Coach and a complimentary Clarity Call (based on availability). Membership is $150 a year for one adult ($15 a month if billed monthly), $200 a year for a couple and $250 a year for a household with dependents; the free tier has occasional email tips only. Members also get discounted rates on one-on-one coaching and group programs (current rates are not published on the membership page, so ask MBHA). Coaching is educational and motivational, not healthcare. 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 (Arthritis UK). 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 should be taken as soon as an attack starts, or it may not work as well. NSAIDs can cause digestive problems, and colchicine can cause diarrhea or stomach aches and interacts with several other medicines (Arthritis UK).

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). Your provider may suggest stopping or changing a medicine that raises uric acid (MedlinePlus); talk with your doctor before changing any medicine (Arthritis UK); 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 even become gout-free (MedlinePlus). If you need ULT, taking it regularly — even when you no longer have symptoms — is important (NHS).

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

At one national chain, Massage Envy, a 60-minute massage costs about $125–$160 without a membership; memberships run about $70–$90 a month for one session, and prices vary by location (The Pricer).

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 may help stop or reduce further attacks — but avoid crash diets (NHS), which can raise urate levels (Arthritis UK). 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). See our Weight Control guide.

Taking medicine every day

Take ULT regularly, even when you no longer have symptoms (NHS); missed doses can make urate levels go up and down and trigger an attack (Arthritis UK). 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, known to lower blood pressure, also lowered uric acid in a feeding trial of 103 adults with raised blood pressure (Juraschek et al., 2016); 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).

Aim for a balanced diet low in fats and added sugars and high in vegetables and fiber (Arthritis UK). In a 26-year study of more than 44,000 men, eating closer to the DASH pattern was linked with a lower risk of developing gout (Rai et al., 2017) — an association, not proof. Your doctor may give you a list of foods to include or limit (NHS), and talk with them before changing your medicines (Arthritis UK).

General wellness

Everyday comfort, sleep and energy

Many people ask what they can do day to day to feel more comfortable, sleep better and have more energy. The habits below come from public health agencies. They are general wellness habits, not treatments for Gout, and they do not replace your doctor’s care. They are not personal stories or testimonials.

  • Sleep habits. The U.S. National Heart, Lung, and Blood Institute suggests going to bed and getting up at about the same time every day, using the hour before bed for quiet time, avoiding caffeine and heavy meals close to bedtime, keeping the bedroom quiet, cool and dark, and limiting naps to about 20 minutes (NHLBI).
  • Gentle movement. CDC says physical activity helps people “feel better, function better, and sleep better,” and that moderate activity such as brisk walking is generally safe for most people (CDC). Ask your doctor what kind and how much is right for you, especially if you have a heart condition or pain in your joints, hips or feet.
  • Relaxation practices. Slow breathing and similar practices are generally considered safe for healthy people, and some reviews suggest they may help with stress. On their own they “don’t seem to be especially promising for sleep,” and a few people report more anxiety or intrusive thoughts, so stop and tell your provider if that happens (NCCIH).

Please note: MBHA makes no medical claims. Results vary. Never stop or change a prescribed medicine without talking to your doctor, and see a doctor about severe or lasting symptoms.

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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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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