Gout Knee

By Chloe Wilson, BSc(Hons) Physiotherapy

Find out about the common causes, symptoms, diagnosis and treatment of Gout Knee

Gout knee is an inflammatory condition characterised by intense pain and swelling of the knee joint. 

Gout is a fairly common condition affecting 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 and the peak age of incidence is 75. Gout is often extremely painful and recurrent episodes are common.

As well as affecting the knee, gout can also affect the big toe, hands, toes, ankles and wrists. It tends to only affect one joint at a time rather than being widespread.

If the knee suddenly becomes hot, painful, red and swollen, it is most likely due to Got Knee.

Here, we will look at the common causes of gout, typical symptoms, diagnosis, effective treatment & prevention of gout knee, and you can even find out about famous gout sufferers!

Causes of Gout Knee

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.

Uric acid crystals associated with gout knee

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 such as the knee.

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.

Risk Factors

Uric Acid

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. 

In fact, approximately 50% of people with gout do NOT have hyperuricemia, high uric acid levels.

There are a number of other 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 knee may develop after an injury or surgery

Gout knee can develop any time after puberty, although in women, it tends to be after the menopause. This is thought to be due to the positive effect of oestrogen until then. 

Gout Symptoms

In most cases, the symptoms of gout develop rapidly over a few hours. Gout symptoms usually start at night due to lower body temperatures. The joint quickly becomes hot, swollen and red and usually becomes extremely sore.

An acute episode of Gout knee

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). 

Gout knee often makes weight bearing activities such as walking and going up and down stairs incredibly painful.

Most cases of gout knee are acute, sudden and short-lived. Left untreated, most cases of gout knee settle down after a couple of weeks.

Unfortunately, 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.

Diagnosing Gout

A purulent knee aspirate from a person with presumed gout

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 of gout by doing blood tests (although these can be unreliable) or by removing a small amount of fluid from the knee 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.

Treatment Options For Gout

Left untreated, gout in knee episodes usually settle in a couple of weeks but can last longer. There are a number of things you can do to help speed up the healing process and prevent further attacks of gout knee:

1) NSAIDS
Non-steroidal anti-inflammatory medications such as ibuprofen/naproxen can work really well if taken as soon as gout symptoms develop NB always check with your doctor before taking any new medications

2) Rest
If you are suffering from gout in your knee, it is important to rest. Elevate your leg to help reduce swelling, and avoid strenuous activity, e.g. limit weight bearing activities

Supplements can be used to help treat Gout Knee

3) Steroids
Steroids, either taken orally or via an injection, can help to reduce the inflammation and pain associated with gout knee

4) Supplements
Many people find that taking supplements help to dramatically reduce both the frequency and intensity of flare-ups of gout. There are a number of different varieties on the market - find out more about gout supplements, how they work and which ones work best

5) Colchicine Medicine
Colchicine helps reduce the build-up of urate but can cause sickness and diarrhoea

6) Ice
Using ice to cool down the joint can help reduce gout pain and swelling. Find out how to safely and effectively use ice for gout knee and visit the ice wraps section for the best ways to apply ice.

Possible Complications

Sometimes, gout spreads from the knee and affects more than one joint at a time, such as the big toe or hands.

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.

This video from Healthline talks about the symptoms, diagnosis, treatment and prevention of gout.

Gout Prevention

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) Lose Excessive Weight: obese people are more likely to suffer from gout - discuss weight loss with your doctor

Avoiding purine rich food such as spinach can reduce the risk of gout knee

3) Avoid Fructose-Sweetened Drinks: such as soda

4) Avoid Purine Rich Food: e.g. oily fish, offal, pulses and certain vegetables e.g. 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) Supplements: There are a number of different supplements on the market that claim to lower uric acid levels and many gout sufferers swear by them. One study showed that an intake of 1,500mg per day of Vitamin C decreases the risk of gout by 45%. Always check with your doctor before starting any gout supplements

7) Drink Plenty of Water: to prevent dehydration . Aim for approximately 1.2 litres daily

Famous Gout Sufferers

Fascinating fact time! I thought you might like to find out about some fellow gout sufferers:

Henry VIII is a famous gout sufferer most likely due to his diet

1) Henry VIII: His love of fine food and wine was most likely his undoing

2) Dick Cheney: Was hospitalised 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

What Next?

Whilst gout knee is not particularly common, it should always be considered with any sudden incidence of pain associated with swelling and redness.

Remember, you should always see you doctor with any new incidence of knee pain or swelling.

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.

  1. Knee Pain Guide
  2.  ›
  3. Conditions
  4.  ›
  5. Gout Knee

Page Last Updated: 19/9/18
Next Review Due: 19/9/20


Your Comments

Share your knee pain experiences with others, whether it be ideas, top tips, things that worked well for you, problems you've had etc.......