Acupuncture in the Treatment of Gout (Acute Gout): A Critical Synthesis of the Evidence

Introduction: Gout is the most common inflammatory arthritis in adults, marked by recurrent painful flares, joint damage, and tophi formation. Standard management includes treatment of acute attacks (NSAIDs, colchicine, corticosteroids) and urate-lowering strategies based on a treat-to-target approach. Acupuncture has been proposed as an adjunctive therapy due to its potential analgesic and anti-inflammatory effects. Objective: To evaluate the efficacy and safety of acupuncture (manual, electroacupuncture, and thermal variations) in acute gout, integrating evidence from randomized controlled trials (RCTs), meta-analyses, and guidelines. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Web of Science, Cochrane Library, SciELO, and Google Scholar (through September 2025). Included studies comprised RCTs, systematic reviews, and guidelines. Extracted data included country, sample size, intervention type and dose, comparators, outcomes (pain, serum urate, inflammatory markers), follow-up, and adverse events. Risk of bias was assessed using Cochrane criteria. Results: Evidence suggests acupuncture and electroacupuncture improve pain and may reduce serum urate and inflammatory markers, especially when combined with pharmacological therapy. Adverse events are rare and mild. However, evidence certainty is limited due to heterogeneity and risk of bias. Conclusion: Acupuncture appears to be a safe adjunct in acute gout management, best used alongside standard therapy with monitoring of serum urate targets.