Knee gout - much more than knobbly knees





This page about knee gout was last reviewed, or updated, on 6 May 2014

The ancient Greek physicians called gout of the knee Gonagra, a word that's occasionally still used. After the feet, including toes, insteps, ankles and heels, gout in the knee is the next most likely attack site, ahead of places such as the elbows, shoulders, hips, wrists, and ears' ridges, and about equal with the hands and fingers.

GOUT IN THE KNEE HAS PLENTY OF PLACES TO GO

The knee has quite a large joint for gout to infest, and there are plenty of other areas of the knee where gout crystals can be deposited. You know where your knee is of course, but medically it is the joint between the femur, the bone from the hips to the knees, and the tibia, the shin bone, one of the two bones that run down from the knees to the ankles. It has gout-inviting meniscus cartilages, ligaments, tendons, other cartilage and bursae, the cushion sacks. There is synovial fluid in the knee joint, in the bursae, and in synovial capsules. And of course the patella, the moveable bone at the front of the knee, more commonly known as the knee cap - so you can even get gout in the knee cap.

So that’s the knee, what does gout do to it?

Quite a lot, if it's allowed to. Gout crystals, which may grow into small but expanding tophi, can be deposited in, or on, all these places, even the front of your patella knee cap, on its bone. Wherever they are deposited, one common effect is stiffening and the other of course will be pain and inflammation. These effects will probably make sufferers immobile.

If there's enough synovial fluid in the knee joint, and the other knee areas mentioned above, and if gout's MSU crystals are deposited in it, this development can be the start of tophi deposits.

Tophi also grows on the bones and eventually, if it's deposited on the bumps at the ends of the femur and tibia (the condyles), it will destroy cartilage, including the two meniscus cartilages between the bones, which together with the synovial fluid, and the bursae, cushion the friction between the bones. Tophi can also grow into  bones.

Out of its heartland  In the other articles about gout in various parts of the body on this website, I've explained the malady's natural homeland is the feet and toes, which is where about 85% of first attacks occur and which can be attacked again and again, and simultaneously with some other place.

When it attacks other body places, (i.e. other than the feet and toes), gout demonstrates its well known truth that it is almost invariably a progressive disease that attacks more locations, and for longer periods of time, as it progresses. Unless successfully treated. 

So a knee gout attack, especially if you've already had an attack elsewhere, is an event that's telling you to re-double your efforts to reduce your uric acid level and be more exact about your gout treatment.

A previous injury makes it less serious However, if you have injured the knee in the past – for example heavy bruising, sprains, a broken bone, joint dislocation – and this is your first gout attack, the previous injury would probably account for why it has attacked the knee. In that case it is not "spreading gout," at this point, and not as serious. However, even without a previous injury, a first gout in the knee flare is possible.

WHAT IS KNEE GOUT LIKE ?

The swelling in the affected knee could be bigger than you imagine. A ballooning up to the size of a melon (but not a watermelon!) has been reported. You may lose control of your leg. It will stiffen and become unbendable, and probably very sore in the usual gout manner. One gout sufferer reported both his knees became dislocated due to the massive swelling.

If you're lucky, you'll be able to get around with a cane or walking stick, and if you're unlucky, you'll be stuck in bed or on a chair. You probably won’t be driving a vehicle. If you are immobile, make sure you have your medications and other necessities by your bedside, day and night, or someone to get them for you.

Knee gout pain Pain will be in the attacked joint and fibrous tissues, and it may extend up to the thighs and down to the ankles and toes. Your knee can be an unwelcome stop-over on a gout tour of your lower body. Generally, knee gout pain is on a par with pain in the toes and feet, possibly less than in the fingers. And don't expect the classic five-day-big-toe-like attack for early gout sufferers. 

As discussed above, knee gout usually means gout has been lurking in your body for some time, probably years. Like elbow gout, a gout knee is a sign that not only is gout spreading, but it is getting more entrenched. And that means longer attacks which could be painful for weeks, not days.

WHAT CAN YOU DO ABOUT KNEE GOUT ?

As with gout in other body areas, only a reduction of the uric acid level to below 6.0 mg/dL in men and about 5.5 mg/dL in women, will hope to deliver the absence of gout attacks, or reduce their frequency and potency. This fall is what must be achieved.

The pH of synovial fluid

You can try to raise the pH of the body's synovial fluid, which is found in many gouty and other places, in addition to the knees. The idea is you make it more alkaline and less acidic.

Among other benefits, which may include less pain and more mobility, this may make the difference between tophi forming or not. Attempting this is quite advanced treatment and you may find a rheumatologist with experience of it.

I mention this idea because there are examples of raised synovial fluid pH being helpful in Sir Alfred Garrod’s classic book on gout, which vividly describes many cases.

But although you can buy pH raising supplements, eat a more alkaline diet, and raise pH in other ways, the pH of the synovial fluid will not be measured so the results of your efforts to raise this fluid’s pH are a matter of faith. If you are a regular pH supplement taker, and for example your knee gout attack is a relatively mild one, this may be an indication that the more alkaline pH of the synovial fluid has had a beneficial effect.

The raised pH numbers of blood and urine do benefit of course, and this pH is measurable (urine) or well established (blood). You can also measure the pH of saliva, which may indicate the pH of synovial fluid, and it is an indication of the general pH of the body.

Stopping knee gout pain  If you've agreed with your doctor  that you can use baking soda (bicarbonate of soda) in water, this has a good record of at least ameliorating the attack, and may end it sooner. The standard drug medication is colchicine, which should be taken in very small amounts, together with an NSAID, probably indomethacin or sodium diclofenac. If they don't stop the pain, injections into the attack site of corticosteroids like prednisone should end it. 

Other emergency treatment involving surgery, is to drain the knee of the crystal infected synovial fluid which may be in the area of the cause of the inflammation. This will probably reduce the pain, but another attack would see it return.

If tophi develops, it can be removed by surgery, but you may have to hunt around for a hospital that can do this.

MORE DEALING WITH GOUT-OF-THE-KNEE TIPS 

1. See a rheumatologist. These are the best kinds of doctors to see about gout, because they specialise (specialize) in all the arthritis diseases, of which gout is one.

2. Natural methods of dealing with gout pain such as ice and Epsom salts are more fully explained on the ankle gout page.

No one can make huge success claims for these, but they might help. The cabbage leaf treatment, and there is a rationale to it, is described on the gout foot pain page.

If you use it successfully please tell us on the Contact Us page. You’ll help other gout sufferers. 

3. There is one consolation about knee gout. Your rheumatologist may find it easier to get fluid out of your knee in the aspiration (arthrocentesis) test to check if there really are gout crystals there. It's said to be easier than getting it out of the big toe.

4. The gout-pain-treatment page has a summary of foods and other substances for gout pain.

Some sufferers report the mere removal of fluid alleviates pain somewhat, probably because some crystals have been removed. If tophi of the knee develop, and this takes years not months, and you become immobile, it can be removed by surgery.

DON'T CONFUSE KNEE GOUT WITH ANOTHER CONDITION

Gout of the knee can be confused with many medical maladies involving the knees, and it has often been misdiagnosed.

As with all gout cases, wherever the attacks are, the real test for gout is a joint aspiration (aka arthrocentesis) test. In the case of suspected knee gout, synovial fluid taken from the knee, is examined for gout's needle shaped crystals which can be seen by a polarizing microscope.

BETTER TREATMENT IN THE FUTURE ?

The new gout drug Krystexxa, (generic name: pegloticase) gained its first medical authority approval in September 2010 from the U.S. FDA. And from the EU in January 2013.But its developers went bankrupt in Autumn 2013, and the new owners have not yet announced plans for its development outside the U.S.

It has demonstrated considerable but not complete success against tophi. It might be more effective against tophi in the knee, and gout generally, than any existing gout drug medication, but it is for a limited group of gout patients. In its trials, it got uric acid down to extremely low levels in many cases. Unlike current anti-gout medications, Krystexxa is not a tablet or capsule. It's a course of injections, at an approved medical center (centre) which gout sufferers visit.

Related pages you might enjoy

Go to our INDEX page for all our gout in various body area pages. See them all and click to those that interest you - gout in the wrist, ankle, toes, ears, hips etc.

Visit our main page about gout crystals. What are they like ?



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