Gout is a common disease primarily seen in middle-aged men. Traditionally, gout presents as a painful and swollen big toe. However, gout can also affect other joints, including the knee joint. So how do you know you have gout in the knee, and what can you do about it?

What is gout?

gout in knee joint showing uric acid crystals

Too much uric acid in your blood leads to gout. We produce uric acid from certain foods containing purines, such as heavy meats, seafood, and alcohol. High levels of uric acid deposit into joints, causing rubbing and leading to inflammation, swelling, and pain. Generally, the big toe is affected, but other joints, such as the ankle and knee joints, are also affected.

Gout occurs in men in their 40s and 50s, although younger people and women can also get gout. It affects about 1-2 people in every 100, meaning over a million people in the USA have gout.

Common gout symptoms in knee

Ususally, gout in the knee will be hot, inflamed, and swollen. Often, it occurs suddenly from no cause and gets worse over hours. Gout can look like an acute infection, so seeing a doctor is essential to make a correct diagnosis. Also, uric acid might attack the tendons at the front of the knee, such as the patellar or quadriceps tendons, rather than the joint.

Sometimes, gout may not present with acute swelling. Instead, you might have a swollen knee and mild discomfort without severe redness or heat. It can be challenging to differentiate between ‘sub-clinical’ gout and other causes of a swollen knee, such as osteoarthritis or rheumatoid arthritis.

How do we diagnose gout in the knee?

Your doctor will ask questions about your symptoms and examine your knee. Blood tests to check uric acid levels and inflammation in your blood will also help. But be aware that uric acid levels in the blood might be normal or low in acute gout attacks (as all the uric acid goes into the joint). Also, an ultrasound or MRI scan can indicate whether the swelling is gout or another cause. Finally, we can take some fluid from the knee joint, also called a knee joint aspiration, to send it for lab testing. If we see typical uric acid crystals, we can confirm the diagnosis.

Other possible causes of a painful swollen knee:

Septic arthritis 

Septic arthritis is due to an infection in the knee. This condition is often confused with gout. Generally, people with an infection are unwell with a fever, although gout can also cause a fever. If there is a suspicion of septic arthritis, seeing a doctor in your local hospital is essential.

Pseudogout

Pseudogout, or CPPD, is acute arthritis caused by the deposit of calcium crystals in the joint. It is more common in older people and affects the knee joint more commonly. It resembles gout with a hot and swollen knee, although the onset is more gradual than acute gout.

Inflammatory arthritis 

Other causes of inflammatory arthritis include rheumatoid arthritis or psoriatic arthritis. Generally, these types of inflammatory arthritis have a slower onset than acute knee gout.

Causes of gout in knee

Generally, the higher the uric acid in the blood, the greater the risk of acute gout. Essential factors that increase uric acid levels include:

  • family history – high uric acid levels are often genetic
  • gender – males are at higher risk
  • Diet – certain foods high in purine increase uric acid. Examples include red meat, prawns, broad beans, cakes, and pastries.
  • alcohol
  • certain medications such as diuretics
  • weight gain

A gout attack is often triggered by an event such as a high intake of purine-rich foods or alcohol intake. Also, an acute injury such as twisting your knee can trigger an attack.

Knee gout treatment

Generally, you can take simple steps to get rid of gout in the knee. Examples include ice, knee compression, and rest from the sport. Also, you need to keep well hydrated and avoid alcohol.

Medications from your doctor can help. For example, anti-inflammatory tablets such as ibuprofen can quickly stop an acute attack and eliminate gout. Similarly, colchicine can prevent gout if taken in the first 24 hours. The colchicine dose is often one tablet three times a day, decreasing to twice a day after a week as the pain settles.

Can you take colchicine with ibuprofen together? 

Yes, both medications treat acute gout and have different actions. However, we favour colchicine for acute attacks as this drug is well tolerated and works quickly. On the other hand, ibuprofen or NSAIDs can cause side effects such as stomach ulcers, high blood pressure, or kidney problems.

Ultrasound-guided cortisone injections: is it beneficial for knee gout? 

Cortisone is a potent anti-inflammatory steroid drug that works almost immediately to stop acute gout. Cortisone can be taken by mouth, but side effects are common. A cortisone injection into the knee joint is effective. Using ultrasound to guide a needle into the joint is essential to improve accuracy and impact. If the knee is swollen, you can drain the knee before giving the cortisone shot.

Generally, a cortisone shot for knee gout takes a few days to start working. However, if given early in an acute attack, it can stop it in its tracks.

What about PRP injections for immediate knee gout pain relief?

PRP injections for gout are only reserved for exceptional cases. Like cortisone injections, PRP injections are anti-inflammatory and will have a beneficial effect. This effect is probably better if the injected knee joint also has osteoarthritis. Nevertheless, the impact of PRP is less than cortisone. Overall, we would only consider PRP injection for gout if the risks of giving a cortisone injection are too high.

Gout knee recovery time

Generally, most acute knee gout attacks settle within a few days if managed well. However, if left untreated, symptoms can take weeks to resolve, and sometimes low levels of swelling remain.

Moreover, recurrent gout attacks are expected. More than 60% of people who suffer a gout attack develop a recurrence within two years—even more reason to prevent ongoing attacks with simple treatments.

Tips on prevention of gout

foods to avoid in gout

Firstly, you need to treat lifestyle factors. Examples include losing weight, reducing alcohol intake, and eating a healthy diet.

Secondly, your doctor may prescribe medications to lower uric acid. The most common drug is Allopurinol. Waiting until an acute attack has settled before starting this drug is essential. Speak to your doctor about whether you should consider this drug. In general, preventative medication such as Alluprinol is helpful if uric acid levels are high (above a level of 500) and you’re experiencing recurrent attacks. It would be best to increase the Allopurinol dose every 1-2 months until your uric acid levels are 350 or below.

Typically, a lifestyle change can reduce uric acid levels. Foods that increase purine and should be avoided include organ meats, sardines, anchovies, prawns, board beans, and foods containing high fructose corn sugar concentrations. In addition, yeast and yeast-based foods such as frozen and canned foods can cause problems. Also, sugar-sweetened beverages and alcoholic drinks increase acid levels. Generally, wine is better than hard liquor or beer.

On the contrary, foods that reduce uric acid include cherries, fruit and vegetables high in vitamin C, low-fat dairy products, and a vegetarian diet. High protein diet and intake of diary products has not been associated with increased got attacks. Also, keeping well hydrated can prevent and treat an attack.

Other frequently asked questions about gout knee:

How long does gout in the knee last? 

Most cases of knee gout are acute and short-lived. Left untreated, most cases settle after a few weeks. However, recurrent attacks are common, with the risk of another attack of knee gout approaching 60% within one year.

Can you get gout in a knee replacement? 

Yes, although gout is relatively rare after knee replacements. Generally, gout in a knee replacement is difficult to differentiate from acute knee joint infection or septic arthritis. The key to diagnosing gout in a knee replacement is finding uric acid crystals in the knee fluid. Also, a history of recurrent gout attacks increases the possibility of gout in a knee replacement.

Can you get gout in your hip? 

Yes, but gout in your hip is extremely rare. Sometimes, gout in your hip can be misdiagnosed as avascular necrosis of the femoral head. Also, gout in the hip doesn’t have the usual features of gout in other joints, such as swelling, redness or increased skin temperature. One clue is that ultrasound of the hip might see a typical double contour line specific to gout. Also, taking fluid out of the hip to analyse for uric acid crystals will help too.

Is gout associated with other health conditions? 

Recent studies suggest that gout is associated with an increased risk of anxiety, depression and heart attacks.

If you have gout, should you stop protein powder supplements? 

No. However, vegetable-based or whey proteins are generally better. 

Final word from sportdoctorlondon on gout in knee 

You must think about gout for acute knee pain and swelling without trauma. Early treatment with medication will stop the symptoms quickly.

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Dr Masci is a specialist sports doctor in London. 

He specialises in muscle, tendon and joint injuries.