Most people associate gout with pain in the big toe joint. While the big toe is the most commonly affected joint, you may be surprised to learn that gout may also affect other joints in the body, such as the knees and elbows.
In fact, many people suffer from gout flares in their knees without even realizing it. Many people dismiss knee pain as a possible injury or as the early signs of aging and joint wear and tear.
Knee pain is a typical sign of a sports or overuse injury, but different types of arthritis may also be to blame. Sometimes knee pain may appear for no apparent reason. If your knee pain and stiffness are accompanied by a burning pain or sensation, and the joint is warm to the touch, you may be experiencing a gout flare.
Many people dismiss the possibility of having gout in their knees because it is so commonly associated with the big toe joint. Gout, on the other hand, may flare up in areas of the body that already have arthritis, such as the knee joint.
Gout May Potentially Spread to Other Joints
Gout flares, in general, tend to progress up the body. If you have pain in your big toe joint and suspect it is gout, a professional rheumatologist can help you get a proper diagnosis.
The knee may experience sudden, intense pain, swelling, redness, warmth, and stiffness when gout is present. Additionally, the knee might be painful to the touch and difficult to move.
If your gout condition is not diagnosed and treated, it may spread from your big toe. It may then begin to have an impact on the joints above, starting at the ankle and moving up to the knee, and eventually reaching the lower spine.
While gout may affect both knees, it tends to manifest more severely in one, particularly if the affected knee is already arthritic.
What Causes Gout in the Knee?
Gout may be caused by high uric acid levels in the blood. According to one study, the body produces approximately 66% of its own uric acid. Uric acid is also produced by the body when purines, which are organic compounds found in some protein-rich foods, are broken down. Uric acid levels are typically controlled by the kidneys by filtering them out of the blood.
Uric acid is a powerful antioxidant that benefits the body at normal levels. When there is too much of it in the bloodstream, however, it may cause hyperuricemia. This could happen if the kidneys do not filter out enough uric acid or if the body produces too much of it.
Excess uric acid may leave the bloodstream and form microscopic uric acid crystals in soft tissues or joints when a person develops hyperuricemia. These crystals could develop around or in the joints because of the typically lower temperature in these regions.
These crystals may accumulate in the knee joint and result in gout-like symptoms like pain, burning, swelling, and redness. Additionally, the knee joint may feel warm to the touch, and crystal buildup may restrict the knee joint’s range of motion. A knee gout flare-up may occasionally make it difficult to walk.
Uric acid crystals are perceived by the immune system as foreign substances, which leads to inflammation that resembles that of infection in both appearance and sensation. That being said, Gout does not develop in everyone who has high uric acid levels. According to studies, approximately 66% of people with hyperuricemia do not have the condition.
How Common Is Gout in the Knee?
Research shows that the big toe joint is where 50% of patients first experience gout flare-ups. However, 35% of patients experience secondary gout flares in the knee if they go undiagnosed and untreated.
If your gout is not treated, other joints may also be impacted. Gout flares affect the midfoot and ankle in 40% of patients, the elbows and wrists in 30%, and the fingers in 15% of patients.
It is not uncommon for patients to find gout in the knee after undergoing exploratory procedures, such as getting an X-ray or ultrasound. That’s typically due to many of them will believe their knee pain is being caused by something else.
What Distinguishes Gout Pain in the Knee?
Having knee pain is unsettling, regardless of the cause. But during a gout flare, the majority of people with knee gout will feel excruciating pain. The skin will appear red and feel warm to the touch, and the knee may noticeably swell.
Although the same symptoms may appear after a knee injury, the pain may appear to have no apparent cause, such as a fall or accident. Additionally, the nighttime onset of gout pain makes it challenging to get any rest.
The first 24 hours of a flare are often the most painful, making it challenging to bend your knee and move around.
Although the medical community is still unsure of why gout flares tend to happen more frequently at night, some researchers think it might be because of the lower body temperatures at night. It is believed that uric acid is more likely to crystalize at lower body temperatures.
Who Is Most Prone to Knee Gout?
A variety of factors could increase your risk of developing gout. A family history of the condition appears to be a leading predictor. According to research, there is a genetic predisposition to high uric acid levels.
- Genetic predisposition: You may be more prone to developing gout if you have close relatives who have the disease.
- Certain medications: A rise in uric acid levels in your body may be a side effect of certain medications, such as diuretics or immunosuppressive drugs. Furthermore, if you are being treated for any underlying health conditions with medications that interfere with normal kidney function, you may be more likely to develop gout.
- Diet and lifestyle: A diet high in sugar, grains, seed oils, and highly processed foods may overwork the body and make it more difficult for the kidneys to remove waste products, including uric acid. Smoking and drinking are obvious risks to general health.
Avoiding or limiting high-purine foods such as certain seafood, organ meats, alcohol, and sugar-sweetened beverages may be beneficial. Nonetheless, researchers believe that medications have a greater impact on uric acid levels than a diet.
Getting a Proper Diagnosis for your Gout Symptoms
If you suspect you have gout but have not been diagnosed, try to see a doctor while you are experiencing symptoms. Gout is easier to diagnose when you’re in the midst of a flare-up, especially one that’s causing swelling, redness, and other visible signs.
Gout may be identified and treated by a rheumatologist, a physician who specializes in arthritis. During your appointment, your doctor will most likely ask you about your diet. They will also ask if you are taking any medications and have a family history of gout.
In order to determine whether a patient has gout or another condition, the doctor will then perform some diagnostic tests. A blood test to check your uric acid levels may also be ordered by your doctor.
Some people have high uric acid levels but do not develop gout. Others have normal uric acid levels but get gout. As a result, your doctor will order additional tests.
An effective way to rule out other possible causes of joint inflammation is by getting a knee X-ray, MRI, or CT scan. Your doctor may also prescribe an ultrasound to look for crystals in your knee, depending on the results of your examination.
Last but certainly not least, doctors may recommend doing a joint fluid test to complete your comprehensive evaluation. To do this, a very small amount of knee joint fluid must be drawn out using a very small needle, and it must then be examined under a microscope to look for any uric acid crystals.
They may recommend that you seek treatment from a rheumatologist, or a specialist in inflammatory arthritis, based on the findings of your examination and tests.
How to Treat Gout on the Knee
Although there is no known treatment for gout, you may manage your knee pain and lessen the frequency of flare-ups with a combination of prescription drugs and home remedies.
Use Doctor-Prescribed Medications
The following medications may help lessen knee gout flare-up pain:
- NSAIDS (nonsteroidal anti-inflammatory drugs) sold over the counter, such as ibuprofen (Advil).
- NSAIDS prescribed by a doctor, such as celecoxib (Celebrex) or indomethacin (Indocin).
- Corticosteroids are pain relievers that may be taken orally or injected into your knee joint.
- Colchicine (Colcrys), is a gout pain reliever that may occasionally cause nausea and other side effects.
To reduce your risk of future flare-ups, your doctor may also prescribe a low daily dose of colchicine.
Other medications that may help you avoid future flare-ups include:
- febuxostat (Uloric) and allopurinol (Zyloprim), which lower uric acid production in the body and may lessen the risk of gout developing in other joints.
- uricosurics, including lesinurad (Zurampic) and probenecid (Probalan), aid in the removal of extra uric acid from the body but may also increase the risk of kidney stones.
Limiting your intake of purine-rich foods and beverages is one of the most effective ways to manage gout. Remember that when your body breaks down purine, it produces uric acid.
This entails consuming less:
- red meat.
- animal organ meats, like liver.
- seafood, particularly tuna, scallops, sardines, and trout.
- sugary beverages.
Eliminating some of these foods may also help you lose weight. Given that being overweight increases your risk of developing gout, this may be an added benefit.
Substitute fruits, vegetables, whole grains, and lean proteins for purine-rich foods. Learn more about what foods to eat and avoid if you have gout.
There are some other home remedies you can try, but they haven’t been thoroughly researched to determine their efficacy. They may, however, provide some relief. Here’s how to put them to the test.
How Long Does Gout in the Knee Typically Last?
Even though gout flare-ups may last for several hours at a time, your knee may continue to hurt for several days or even weeks. While some people only experience one flare-up in their lifetime, others do so frequently.
However, it’s crucial to keep in mind that gout is a chronic condition, which means it lasts a long time and calls for ongoing management. Although medication and dietary changes may significantly improve your condition, you still run the risk of experiencing a flare-up.
Furthermore, finding the right combination of dietary changes and medication that works for you may take some time. Don’t be disheartened if things don’t seem to be getting better right away.
Are There Any Long-Term Risks?
Gout flare-ups may affect more than one joint at a time and become more severe and frequent over time. Gout-related inflammation may cause permanent damage to your knee joint if left untreated, especially if you have frequent flare-ups.
Tophi, or lumps of uric acid crystals, may form around your knee over time. Although these lumps are not painful, they may exacerbate swelling and tenderness during a flare-up.
Additionally, gout sufferers are susceptible to infections, which they must treat right away. Gout infections are more likely to occur in people with diabetes.
Early gout treatment, however, may frequently help manage the condition and lower the risk of serious side effects, like joint damage.
Signs You May Have Gout in the Knee
A gout of the knee is characterized by inflammation of the knee joint and surrounding tissues. It may also cause inflammation in the prepatellar bursa, which is located in front of the kneecap. Bursae are fluid-filled sacs that act as cushions between soft tissues and bones in the body.
Gout in the knee symptoms include:
- Swelling in and around the knee.
- Pain that is often sudden and severe, limiting knee use.
- Skin discoloration or shiny skin around the knee.
- A warm sensation in or around the knee.
- Tenderness to the point where the joint cannot withstand touch, weight, or pressure.
- As the inflammation subsides, the skin becomes itchy, flaky, and peeling.
Gout symptoms frequently worsen during flare-ups, which usually last 3–10 days. It could take months or years for a person to have another gout flare-up after the initial one. But without preventive care, a lot of people experience another flare-up within two years.
Total Knee Replacement Surgery and Gout
According to a study published in Osteoarthritis & Cartilage, gout may be linked to an increased risk of severe knee osteoarthritis, which warrants total knee replacement surgery. The progression of knee osteoarthritis may be slowed by treating gout or hyperuricemia, according to medical professionals.
Nevertheless, dietary changes and weight loss continue to be the cornerstones of treatment for knee osteoarthritis. A higher body mass index is widely acknowledged as the single most important risk factor for knee osteoarthritis, aside from age and gender.
As a result, in severe knee osteoarthritis, obesity is the most significant attributable risk factor for total knee replacement.
An artificial joint is used to replace the diseased or damaged knee joint during total knee replacement surgery. The accumulation of uric acid crystals in gout may lead to joint damage and inflammation, complicating knee replacement surgery. Therefore, it makes the surgery more challenging to perform and could raise the possibility of complications.
Before performing knee replacement surgery on a patient with gout, their doctor will typically want to make sure that their gout is well-managed. This might entail treating gout with drugs that lower blood uric acid levels and stop crystal growth in the joint.
The surgeon will take precautions to lessen injury to the joint and surrounding tissues during the procedure itself. They will also take measures to avoid infection, which might be a risk in gout sufferers. The patient might need to keep taking medications to manage their gout and stop further flare-ups after surgery.
Anyone considering knee replacement surgery should talk to their doctor about their medical history and any underlying health conditions, such as gout, to make sure they receive the right care and lower their risk of complications.
Gout Recurrence Following Total Knee Arthroplasty (TKA)
According to the findings of a study published in The Journal of Arthroplasty, recurrence of gout may be more likely after total knee arthroplasty (TKA) in patients with a prior history of gout.
The impact of TKA on gout was examined by researchers from Tulane University School of Medicine in Louisiana, New Orleans. The PearlDiver Mariner database, which includes information on 91 million US patients between 2010 and 2020, was used to compile the data.
Prior to TKA, patients with preexisting gout were compared to those without a gout diagnosis. To account for cohort differences, a 1:1 matching method was employed.
The study included a total of 17,463 people, both with and without gout prior to TKA. Participants in the gout cohort and control group were 67 years old on average, and 39.6% and 39.6% were women, respectively.
Two years after TKA, 53.8% of the gout group had a recurrence, while 3.6% of the control group had gout. The groups had comparable rates of incision and debridement, prosthetic loosening, and periprosthetic fracture (0.4%-0.7%) at 1 year.
However, the group with preexisting gout had a higher rate of revisions and prosthetic joint infections.
On the other hand, when the study was limited to patients with gout in their operated knee, those with vs. those without gout recurrence had a higher risk of prosthetic loosening. At 2 years, patients with gout in their operated knee were more likely to experience prosthetic loosening, prosthetic joint infection, and revision.
The authors of the study concluded that proper diagnosis and management of gout patients in the perioperative setting is critical for reducing the risk of postoperative gout recurrence. Reducing gout attacks after primary TKA could help reduce the risk of poor joint outcomes.
Gout and Severe Osteoarthritis of the Knee
Gout is linked to a higher risk of developing severe KOA, especially in lean women, suggesting that crystal arthritis may contribute to the development of OA.
The leading cause of musculoskeletal disability, knee osteoarthritis (KOA), places a significant health burden on both individuals and the global population.
Age, female gender, and body mass index (BMI) are the known risk factors, according to studies. Recent research, however, has examined the role of crystal deposits and the cellular, biomechanical, and biochemical factors that are connected to cartilage degeneration, the primary symptom of osteoarthritis.
Although there is growing evidence that calcium crystals play a significant pathogenic role in OA, the connection between OA and gout is less certain.
Gout is crystal-induced arthritis brought on by long-term hyperuricemia that results in the deposition of the monosodium salt of uric acid. Most doctors intuitively believe that the presence of OA in gout results from secondary joint damage caused by chronic gouty arthritis.
One study sought to determine whether gout increased the risk of developing KOA severe enough to require surgical intervention. There were 1435 incident cases of TKR due to severe KOA among the 51,858 subjects included in the analyses after a mean (SD) follow-up time of 9.7 (2.5) years.
Self-reported gout sufferers were more likely to be men, lifelong smokers, and frequent drinkers of alcohol. In addition, they were more likely than those without gout to be more educated, have higher BMIs, and engage in more physical activity.
Self-reported histories of hypertension, diabetes mellitus, coronary heart disease, stroke, and other arthritis were more common among those with a history of gout.
In summary, this study discovered that severe KOA was more likely to develop TKR when gout was present.
The mainstay of KOA treatment is still lifestyle changes and weight loss. The study does, however, have implications for future KOA management, implying that urate-lowering therapy, particularly in lean women, may reduce the risk of developing severe KOA that requires TKR.
Gout is a chronic condition with no cure, so you’ll need to monitor it for a while. While finding the right management approach may take some time, many people with gout find that a combination of mediation and lifestyle changes is effective.