What Is Acute Gout
Acute gout is characterized by a sudden onset of severe throbbing and crushing pain, usually in a single joint . It is often described by the patient as the most severe pain ever experienced, and known clinically as excruciating pain. Pain reaches its maximum intensity within 5 hours of its onset. It can be as severe as to wake up the patient from their sleep in the middle of the night or in the early morning.
The affected joint is also tender to the touch, and may become sensitive even to the touch of clothing over the skin. Other features of acute gout include swelling of the joint and erythematous, warm, and shiny skin over the affected articulation. Most patients with acute gout show features of synovitis, bursitis, cellulitis, and tenosynovitis. In other words, the articulation and surrounding tissues go through a process of acute inflammation. This is especially the case when a bigger joint such as the knee is involved. In acute gout of the knee, the patient is usually pyretic, patient complains of malaise, and may feel disoriented and confused. When the acute attack is resolved, the skin over the affected joint is desquamated and itchy. Some patients experience cluster attacks in different joints than the primarily affected joint while some patients may experience milder episodes lasting for only a few days.
Pain And Swelling Are Gouts Calling Cards
The most frequent signs of a gout attack are swelling, tenderness, redness, and a sharp pain in your big toe. These attacks are most common at night when you are sitting still and laying flat on your back. While gout usually manifests in the big toe, you may also experience gout attacks in your foot, ankle, or knees. The attacks can be short or long, anywhere from a few days to weeks and you may not have another attack may for months or years.
How Gout Can Affect Your Knee
Gout is a painful form of inflammatory arthritis that usually affects the big toe, but can develop in any joint, including one or both of the knees. It forms when your body has high levels of uric acid. This acid forms sharp crystals that cause sudden bouts of pain, swelling, and tenderness.
When gout affects the knee, it can make everyday movements, such as walking or standing, painful or uncomfortable. While theres no cure for gout, there are several treatments that can help to prevent flare-ups and control painful symptoms.
Read on to learn more about gout and how it can affect your knee.
You May Like: How To Whiten Knees And Elbows
How To Prevent Eye Complications
The best way to manage any symptoms of gout is to keep healthy levels of uric acid in the blood. This goal can be achieved with medication and make dietary changes. Your doctor will recommend the best treatment plan for acute attacks and maintenance.
You should limit or even avoid foods that are high in purine . Choose more often complex carbohydrates from whole grains, fruits and vegetables and fewer refined carbs from white bread and cakes. Limit foods sweetened with high fructose corn syrup such as soft drinks. Drink plenty of water because it will help you remove the uric acid from the body, while avoid alcohol .
If you need to lose some extra pounds, do so, but be careful, and use a combination of exercise and a healthy diet. Avoid crash diets or low carb diets-they can trigger problems because there is a risk of ketosis .
Related Topics :
How To Ease Into Walking After A Gout Flare Up
Following an acute gout attack, you might not feel much like moving. You are probably worried that the instant you try to move the affected joints, you will feel the sting of uric acid crystals. The good news is that your body has the ability to recover. There are a few steps that you can take to ease into walking again following a gout flare-up. These include:
Why Do Gout Attacks Happen More At Night
Gout attacks happen more at night and in the early morning rather than during the day. You may have an attack start during your sleep. The reasons this happens are not entirely known, but some of the leading ideas are dehydration, lower body temperature, and changes in hormone levels during sleep. Talk to your doctor about ways to prevent gout attacks during your sleep.
How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
Recommended Reading: Why Do My Knees Hurt When Its Cold
Treatment For Knee Gout Symptoms
As mentioned earlier, moving swiftly to neutralize the acidic reaction as early as possible is the best course of action both as gout treatment and gout prevention. There are several suggestions that can be implemented:
- Mix baking soda and water and drink it this is the fastest way to neutralize the uric acid. This can help to dissolve the crystals that have already formed and also work to keep the uric acid that hasnt crystallized in solution
- Soak towels in warm water and Epsom salts and wrap the knee then alternate with towel-wrapped icepacks
- Eat fresh celery, apples, cherries, and bananas these are strong antioxidants and alkalizing foods
- Drink clean filtered water 8oz every half hour until all knee gout symptoms have completely disappeared
Is Knee Pain Due To Gout Or Something Else
Most people with gout in the knee experience intense pain during a gout attack. Swelling may also be noticeable during an active flare, as well as redness and warmth.
The pain may develop in the night and hurt continuously for up to two weeks before the flare subsides, with the most intense pain in the first 24 hours. But if gout is not treated, typically with medication to lower uric acid levels, gout flares will recur and over time and affect more joints, including the knee.
Doctors cant say for sure why gout flares occur more often at night but, according to a 2015 study, it might be because your body temperature goes down at night, which could make uric acid more likely to crystallize.
Although the pain of a gout attack is distinct, there may be other reasons for your knee pain you should be aware of.
Your knee pain could be caused by buildup of different kinds of crystals called calcium pyrophosphate . Doctors can examine fluid in your inflamed knee to determine if the crystals are uric acid or calcium pyrophosphate.
Recommended Reading: How To Pop Your Knee
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
How To Prevent Knee Gout
A general rule in medicine is that prevention is the best form of treatment, as never developing the condition through proper preventive measures will save you from distress as well as expensive medical bills. The following are recommendations to follow to prevent the development of gout:
Related: Gout is on the rise
Mohan Garikiparithi got his degree in medicine from Osmania University . He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine , and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.
Read Also: Why Do My Knees Crack When I Squat
The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:
Read Also: Do Compression Sleeves Help With Knee Pain
Common Gout Knee Symptoms
In most cases, the symptoms of gout in knee develop rapidly over a few hours.
Common gout knee symptoms include:
- Pain & Swelling: The knee joint quickly becomes hot, swollen and red and usually becomes extremely sore
- Night-Time Onset: Gout knee symptoms usually start at night due to lower body temperatures
- Skin Changes: the skin around the knee joint often looks shiny and there may be small, firm lumps under the skin, known as trophi
- Fever: Sometimes, gout results in a raised body temperature
- Reduced Function: Gout knee often makes weight-bearing activities such as walking and going up and down stairs incredibly painful
Southern Cross Medical Library
The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.
Read Also: How To Whiten Knees And Elbows
Management Of Knee Gout Flares
The definite diagnosis of gout is made by needle aspiration of the joint fluid, which is studied to detect urate crystals. The aspirate from the knee joint contains crystals, even during the asymptomatic stage after an acute attack. Treatment should include lifestyle modifications to decrease the production of uric acid, weight management, and reductions in the intake of alcohol.
Local ice packs are used to decrease the signs of inflammation. For acute episodes, NSAIDs are used as the drug of choice, but joint aspiration can also relieve the pain. To decrease the inflammation, corticosteroid injection can be administered directly into the joint, and allopurinol and colchicine can be used to decrease inflammation. The patient is given a urate-lowering therapy in cases of recurrent gouty attacks, when there is evidence of joint damage, very high uric acid levels, and renal problems.
Soloway, S. . Tophaceous gout in a knee with total joint replacement. JCR: Journal of Clinical Rheumatology, 17, 48.
Ko, K. H., Hsu, Y. C., Lee, H. S., Lee, C. H., & Huang, G. S. . Tophaceous gout of the knee: revisiting MRI patterns in 30 patients. JCR: Journal of Clinical Rheumatology, 16, 209-214.
Schlesinger, N., Schumacher, R., Catton, M., & Maxwell, L. . Colchicine for acute gout. Cochrane Database of Systematic Reviews, .
Causes Of Gout In The Knee
High uric acid levels in the blood can cause gout.
The body produces about 66% of uric acid naturally. Uric acid also forms when the body processes purines, which are organic compounds found in some protein-rich foods.
The kidneys usually help control the levels of uric acid by filtering it out of the blood.
This may occur if the kidneys do not filter out uric acid properly or if the body produces too much of it.
When a person develops hyperuricemia, excess uric acid may leave the bloodstream and form microscopic uric acid crystals in soft tissues or joints. These crystals may form around or in the joints because the temperature in these areas tends to be lower.
The immune system recognizes uric acid crystals as foreign particles, causing inflammation that looks and feels similar to that from an infection.
However, not everyone with high uric acid levels develops gout. Around 66% of people with hyperuricemia do not experience the condition.
Recommended Reading: Fluid On The Knee Remedies
How Long Does Gout In The Ankle Last
Gout flare-ups can last for several hours at a time, but you may feel pain in your ankle for days or weeks. Some people only have one flare-up in their life, while others have them several times a year.
Keep in mind that gout is a chronic condition, meaning it lasts for a long time and requires ongoing management. Dietary changes and medications can make a big difference, but youll also be at risk of having a flare-up.
Keep in mind that it can also take some time to find the right combination of diet changes and medication that works for you. Dont be discouraged if things dont seem to be improving right away.
What Are The Causes And Triggers Of Gout In The Knee
The buildup of uric acid in the body is known as hyperuricemia. Your body produces uric acid when it breaks down purines. These are compounds found in all your cells. You can also find purines in several types of food, especially red meat and some seafood, as well as alcohol and some sugar-sweetened drinks.
Usually, uric acid passes through your kidneys, which help to eliminate extra uric acid in your urine. But sometimes, theres too much uric acid for your kidneys to handle. In other cases, the kidneys cant process typical amounts of uric acid due to an underlying condition.
As a result, more uric acid circulates throughout your body, ending up in your knee as uric acid crystals.
4 percent of adults in the United States. It tends to be more common in men because women usually have lower levels of uric acid. But after menopause, women start to have higher uric acid levels. As a result, women tend to develop gout at an older age than men do.
Experts arent sure why some people produce more uric acid or have trouble processing it. But theres evidence that the condition is often genetic.
Other things that may increase your risk of developing gout include:
- consuming a lot of high-purine foods
- consuming foods and drinks, especially alcohol, that increase uric acid production
- being overweight
Read Also: Can I Regrow Cartilage In My Knee
How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.