The quality of evidence is downgraded by study limitations (lack of allocation concealment and blinding), and by imprecise results.
Topical ice in adjunct to medical therapy is recommended for managing oligoarticular attacks of acute gout.
The recommendation is strong because potential benefits of the intervention clearly exceed plausible harms, and resource consumption of the intervention is low.
A Cochrane review [Abstract] 1 included 1 study with 19 subjects. The study compared the addition of topical ice therapy (applied for 30 minutes, four times per day) to the combination of oral prednisolone (30 mg/day x 2 days, 20 mg/day x 2 days, 10 mg/day x 2 days) and colchicine (0.6 mg/day) against an identical medication regimen without topical ice therapy, over 6 days. Topical ice therapy provided significant additional benefit over drug therapy alone with respect to pain, but did not significantly reduce swelling during acute gout episodes (table T1). The absolute reduction was 33% less pain with topical ice (8% to 58% reduction). Target joint function, quality of life, patient global assessment, and study participant withdrawals due to adverse events were not reported.
| Outcome | Control (Drug therapy alone) | Intervention (Topical ice + drug therapy) | Number needed to treat (NNT) | Participants (studies) |
|---|---|---|---|---|
| Pain reduction in0 to 10 cm visual analogue scale (VAS); 0 is no pain | The mean pain reduction in the control group was 4.42 cm | The mean pain reduction in the intervention group was 3.33 cm greater(5.84 to 0.82 greater) | 3 | 19 (1) |
| Reduction of joint inflammation;joint circumference (cm) | The mean reduction of joint inflammation in the control groups was3.83 cm | The mean reduction of joint inflammation in the intervention groups was2.07 cm higher(1.56 lower to 5.7 higher) | not calculated, statistically non-significant results | 19 (1) |
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