Can vitamin C be used to treat gout?

Vitamin C is Not Recommended for Gout Treatment

Vitamin C supplementation is conditionally recommended against for patients with gout, regardless of disease activity. 1

Evidence Against Vitamin C for Gout

The 2020 American College of Rheumatology (ACR) guideline for gout management explicitly recommends against adding vitamin C supplementation for gout patients. This recommendation is based on low-quality evidence but represents the most current expert consensus 1.

The scientific rationale for this recommendation is supported by clinical trials showing minimal to no benefit:

• A randomized controlled trial found that vitamin C (500 mg/day) produced clinically insignificant changes in serum urate levels in gout patients 2
• The reduction in serum urate levels was significantly less with vitamin C compared to allopurinol (mean reduction of only 0.014 mmoles/liter [0.23 mg/dl] with vitamin C versus 0.118 mmoles/liter [1.9 mg/dl] with allopurinol) 2
• Despite increasing plasma ascorbate levels, vitamin C failed to demonstrate meaningful urate-lowering effects in patients with established gout 2

Why Vitamin C Doesn't Work Well for Gout

The ACR Voting Panel specifically reviewed the data on vitamin C and reached consensus that the evidence was insufficient to support its use in gout patients 1. Two small RCTs (n=29 and n=40) showed only clinically insignificant changes in serum urate concentrations for patients taking vitamin C 1.

A 2021 Cochrane review further confirmed the lack of high-quality evidence supporting vitamin C for gout treatment. The review found that allopurinol reduced serum uric acid levels significantly more than vitamin C 3.

What Works Better Than Vitamin C

For gout management, the ACR strongly recommends:

1. For acute gout flares: Oral colchicine, NSAIDs, or glucocorticoids (oral, intraarticular, or intramuscular) as first-line therapy 1

2. For urate-lowering therapy: A treat-to-target strategy with medications like allopurinol to achieve and maintain serum urate levels below 6 mg/dl 1

3. For lifestyle modifications:

   • Limiting alcohol intake
   • Limiting purine intake
   • Limiting high-fructose corn syrup
   • Weight loss for overweight/obese patients 1

Clinical Pitfalls to Avoid

1. Don't rely on vitamin C as monotherapy: The uricosuric effect of modest-dose vitamin C appears to be small in patients with gout, whether used alone or combined with allopurinol 2

2. Don't delay effective treatment: Focusing on unproven supplements may delay initiation of effective urate-lowering therapy, potentially leading to more flares and joint damage

3. Don't overemphasize dietary interventions: While dietary modifications are important, they typically yield only small changes in serum urate concentration. Medications remain the cornerstone of effective gout management 1

4. Avoid patient-blaming: When discussing dietary recommendations, ensure discussions are not misinterpreted as "patient-blaming," as patients frequently feel stigmatized when discussing gout with their providers 1

While a recent trial (Physicians' Health Study II) suggested vitamin C might modestly reduce the risk of new gout diagnoses in middle-aged male physicians 4, this preventive effect does not translate to effective treatment for established gout. For patients already diagnosed with gout, the evidence clearly supports pharmacological approaches over vitamin C supplementation.