Gout, including gout knee, is a common, painful condition. It is commonly characterised by intense pain, swelling and redness.
Gout affects approximately 1-2 people in every 100, affecting one million Americans each year. Men are 2-3 times more likely to be affected than women. The peak age of incidence is 75.
The most common place to get gout it the base of the big toe. It can also affect the knee, hands, toes, ankles and wrists. Gout knee should be considered when the knee suddenly becomes hot, painful, red and swollen. Here we will look at the common causes of gout, symptoms, diagnosis, treatment & prevention, and you can even find out about famous gout sufferers!
Gout develops when there are high levels of uric acid (aka urate) in the blood. Uric acid is a waste product of many food sources. It normally passes out in our urine, but sometimes there is a problem with how the body metabolises (breaks down) the uric acid. This can either lead to the kidneys not passing urate quickly enough (causing 90% of cases), or your body produces too much urate (causing less than 10% of cases).
If the level of uric acid is too high, crystals can form in your soft tissues, usually around one joint. The crystals cause an inflammatory response in the tissues leading to hot, swollen, red and painful joints. The crystals tend to form at cool temperatures, which is why gout is so common in the hands and feet. Uric acid levels are often raised for a number of years before the symptoms of gout knee develop.
There are a number of factors that can predispose you to gout in the knee:
1) Genetics: there is thought to be a genetic link in
about 20% of cases
2) Age: most commonly affects people over 40 with the peak incidence at 75
3) Obesity: especially rapid weight gain. A BMI >35 increases the risk three times
4) Diet: accounts for approximately 12% of cases. Risk factors include excessive alcohol intake especially binge drinking, fructose-based drinks and seafood
5) Medical Conditions: Kidney disease and/or metabolism problems
6) Drug Treatments: most commonly diuretics (known as water tablets) used to treat high blood pressure, heart failure and oedema.
7) Trauma: gout may develop after an injury or surgery
Some people are more susceptible to gout than others and there is often little correlation between the levels of uric acid in the blood and the symptoms of gout. Approximately 50% of people with gout do not have hyperuricemia (high uric acid levels)
Gout knee can develop anytime after puberty, although in women, it tends to be after the menopause, which is thought to be due to the positive effect of oestrogen until then.
People usually suffer from acute episodes of gout where the symptoms come on rapidly over a few hours. Gout symptoms usually start at night due to lower body temperatures. The joint becomes hot, swollen and red and usually becomes extremely painful.
The skin around the joint often looks shiny and there may be small, firm lumps under the skin. Sometimes, gout causes a fever (raised body temperature). Left untreated, it usually settles down after a couple of weeks. Gout knee often makes weight bearing activities eg walking extremely painful
Repeat episodes are common and most people will suffer a recurrence anywhere from 6 months to 2 years later. 60% of gout sufferers will have a recurrence within 1 year.
Your doctor can normally diagnose gout knee by from what you
tell him about your symptoms and your history such as any risk factors or
previous episodes. He can confirm the
diagnosis by doing blood tests (although these can be unreliable) or by
removing a small amount of fluid from the joint (known as aspiration). The fluid is examined under a microscope,
looking for the presence of excessive uric acid crystals. Kidney function tests may also be done to confirm the diagnosis of gout knee.
Left untreated, gout in knee episodes usually settle in a couple of weeks. But there are a number of things you can do to help speed up the healing process and prevent further attacks:
1) NSAIDS: non-steroidal anti-inflammatories such as ibuprofen/naproxen can work really well if taken as soon as symptoms develop NB always check with your doctor before taking any new medications
2) Rest: Elevate your joint to help reduce swelling and avoid strenuous activity eg limit weight bearing activities if you suffer from gout knee
3) Steroids: Either taken orally or an injection
4) Colchicine medicine: reduces the build up of urate but can cause sickness and diarrhoea
Sometimes, gout spreads and affects more than one joint at a time. There is also a risk of the uric acid causing crystals to form in the kidneys which can lead to inflammation, scarring and kidney stones.
The incidence of gout has doubled over the last 20 years. This is thought to be due to the increase in life expectancy, dietary changes and an increase in gout-associated diseases. There are a number of things you can do to help with gout prevention:
1) Avoid excessive alcohol intake: alcohol can increase urate levels especially beer, stout and fortified wines
2) Avoid fructose-sweetened drinks
3) Lose Excessive Weight: obese people are more likely to suffer from
gout - discuss weight loss with your doctor
4) Avoid purine rich food eg oily fish, offal, pulses and certain
vegetables eg asparagus and spinach.
This advice has been around a long time, but some more recent studies
are now questioning this
5) See your Doctor: Get your doctor to review your regular medications in case any of them may be predisposing you to gout. For example, Allopurinol inhibits the formation of urate, probenecid increases its excretion by the kidneys
6) Vitamin C: One study showed that an intake of 1,500mg per day decreases the risk of gout by 45%. Always check with your doctor before starting any supplements
7) Drink plenty of water: to prevent dehydration. Aim for approximately 1.2litres
Fascinating fact time! Thought you might like to find out about some fellow gout sufferers:
1) Henry VIII: His love of fine food and wine was most likely his undoing
2) Dick Cheney: Was hopsitalised for side effects of medications he was taking for a foot ailment
3) Jared Leto: This young actor developed gout after having to pile on the pounds for his role as John Lennon's killer in Chapter 27
4) Ansel Adams: The famous photographer had problems lugging his photography equipment around due to gout
5) Maurice Cheeks: Former NBA player & coach developed gout in his 40's and said he had "never experience pain like it as an athlete" Source: AARP Article
Whilst gout knee is not particularly common, it should always be considered with any sudden incidence of pain associated with swelling and redness. Always see you doctor with any new incidence of pain.
If gout knee is not sounding like your problem, visit our common knee conditions page to find out about other common knee problems, or visit the knee pain diagnosis section for help working out what is causing your pain.