Hot vs. cold fomentation in gouty arthritis: A comparative study

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Created On: 12/05/2025

Gouty arthritis, a painful inflammatory condition driven by uric acid crystal buildup in the joints, often elicits intense discomfort, swelling, and restricted mobility.

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Key take away

Cold fomentation is more effective than hot fomentation for acute gouty arthritis, providing better pain relief, reducing swelling, and improving joint mobility. Contrarily, hot fomentation may worsen symptoms.

Background

Gouty arthritis, a painful inflammatory condition driven by uric acid crystal buildup in the joints, often elicits intense discomfort, swelling, and restricted mobility. While thermal therapies like hot and cold fomentation are frequently employed to alleviate musculoskeletal pain, their role in acute gout remains unclear.

Hence, this randomized controlled trial sought to explore whether heat or cold offers greater relief during acute gout flares by comparing their effects on pain intensity, swelling reduction, joint flexibility, and patient satisfaction.

Method

In this study, 2,400 patients (aged 30–70 years) suffering from acute gouty arthritis were assigned to:

Group A (Hot fomentation): Treated with hot pack therapy (38°C–42°C) on the affected joint
Group B (Cold fomentation): Treated with cold pack therapy (5°C–10°C) on the affected joint

Both therapies were applied twice a day for 20 minutes over 5 days along with standard gout management. Using visual analog scale (VAS), pain severity was estimated. Patient satisfaction, range of motion, and joint circumference were assessed at baseline, day 3, and day 5.

Result

Compared to hot fomentation, cold fomentation was more efficient in easing pain, joint swelling, and flare-ups. It also led to greater improvements in joint mobility and was linked with remarkably higher patient satisfaction, making it the preferable option for tackling symptoms (Table 1).

Conclusion

For acute gouty arthritis management, cold fomentation proved more beneficial than hot fomentation. It offered superior pain relief, lessened swelling, improved joint mobility, and diminished symptom aggravation. In contrast, hot fomentation not only provided minimal relief but also exacerbated symptoms in many cases. These findings highlight cold therapy as the optimal thermal approach for gout flares, while heat application should be reconsidered due to its potential drawbacks.