Gout is a common disease, mainly affecting middle-aged men. Traditionally, it presents as a painful, swollen big toe — but gout can affect other joints too, including the knee. So how do you know if you have gout in the knee, and what can you do about it?
This page focuses specifically on the knee. For the fastest ways to settle a flare and the full diet/prevention plan, see our main guide on immediate gout pain relief.
What is gout?
Excess uric acid in the blood causes gout. We produce uric acid when breaking down purines from foods such as heavy meats, seafood, and alcohol. High uric acid levels deposit as crystals in joints, causing inflammation, swelling, and pain. The big toe is the classic site, but the ankle and knee are commonly affected, too. Gout affects about 1–2 people in every 100.
Symptoms of gout in the knee
Gout in the knee is usually hot, inflamed, and swollen. It often comes on suddenly, without an obvious cause, and worsens over hours. Because it can resemble an acute infection, seeing a doctor for a correct diagnosis is essential. Sometimes, uric acid attacks the tendons at the front of the knee — the patellar or quadriceps tendons — rather than the joint itself.
Gout doesn’t always present with dramatic swelling. Some people have a swollen knee with only mild discomfort, without marked redness or heat. This ‘sub-clinical’ symptoms of gout in the knee can be hard to tell from other causes of a swollen knee, such as osteoarthritis or rheumatoid arthritis.
How do we diagnose?
Your doctor asks about your symptoms of gout in the knee and examines the knee. Blood tests (a rheumatoid panel) assess uric acid and inflammation, though be aware that uric acid can read normal or low during an acute attack, because it’s all gone into the joint. Ultrasound or MRI can help determine whether the swelling is due to gout or another cause. The most definitive test is aspirating fluid from the knee and finding the typical uric acid crystals under the microscope.
Other causes of a hot, swollen knee
Because gout mimics other serious conditions, these must be excluded:
- Septic arthritis — infection in the knee, often mistaken for gout. People are usually unwell with fever (though gout can cause fever too). Suspected septic arthritis is an emergency — go to your local hospital.
- Pseudogout — caused by calcium crystals rather than uric acid. It’s more common in older adults, often affects the knee, and resembles gout, but tends to come on more gradually.
- Inflammatory arthritis — rheumatoid or psoriatic arthritis, which usually has a slower onset than acute knee gout.
This swollen-knee differential is the most important reason to get a hot, swollen knee assessed rather than assuming it’s gout.
Treatment
The principles are the same as for gout elsewhere, with a few knee-specific points.
Simple measures for symptoms of gout in the knee help straight away — ice, knee compression, rest, hydration, and avoiding alcohol. Medication settles an acute attack: ibuprofen or colchicine (one tablet three times daily, reducing after a week). For the full medication and prevention plan, see our guide to immediate gout pain relief.
Cortisone injection
A knee lends itself particularly well to injection treatment. Cortisone is a potent anti-inflammatory that works almost immediately. A cortisone injection into the knee joint is very effective — and if the knee is swollen with fluid, we drain it first, then inject. We use ultrasound guidance to place the needle accurately. Given early in an attack, it can stop knee gout in its tracks.
Gout knee recovery time
Most acute knee gout attacks settle within a few days with the right treatment. Untreated, symptoms can take weeks to resolve, with lingering low-grade swelling. Recurrence is common — more than 60% of people have another attack within two years, which is why preventing future attacks matters. The full prevention plan (weight loss, diet, and uric-acid-lowering medication such as allopurinol) is covered on our immediate gout pain relief page.
Frequently asked questions
How long does gout in the knee last?
Most knee gout is acute and short-lived, settling within days if treated and a few weeks if not. Recurrent attacks are common, with the risk of another approaching 60% within a year, so prevention is key.
Can you get gout in a knee replacement?
Yes, though gout after knee replacement is relatively rare. It’s hard to distinguish from a knee joint infection, so finding uric acid crystals in the joint fluid is the key to diagnosis. A history of recurrent gout makes it more likely.
What’s the difference between gout and pseudogout?
Both cause a hot, swollen knee, but pseudogout is from calcium crystals, affects older adults, and comes on more gradually. Gout is from uric acid and tends to flare more suddenly. Joint fluid analysis tells them apart — uric acid crystals are needle-shaped, calcium crystals are rod-shaped.
Is a swollen knee always gout?
No — and this matters. A hot, swollen knee can be due to septic arthritis (an emergency), pseudogout, inflammatory arthritis, or gout. That’s why a hot, swollen knee should always be assessed rather than assumed to be gout.
Can you get gout in both knees?
It’s possible, but less typical — gout usually starts in one joint. Pseudogout and inflammatory arthritis are more likely to affect both knees, which is another reason to confirm the diagnosis.
Final word from Sport Doctor London
Always think of gout when there’s acute knee pain and swelling without trauma — but never assume it. The swollen-knee differential, especially septic arthritis, makes an accurate diagnosis essential. Early treatment, sometimes with an ultrasound-guided cortisone injection, quickly settles knee gout.
To book a knee assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
Had a cortisone on Thursday 14:09/23. Yesterday (Monday 18/09/23) was the first time I think it had any impact. I am suffering with gout and it has flared up after chemotherapy and non-chemotherapy treatments from the cancer unit