Is Knee Pain Due To Gout Or Something Else
Most people with gout in the knee experience intense pain during a gout attack. Swelling may also be noticeable during an active flare, as well as redness and warmth.
The pain may develop in the night and hurt continuously for up to two weeks before the flare subsides, with the most intense pain in the first 24 hours. But if gout is not treated, typically with medication to lower uric acid levels, gout flares will recur and over time and affect more joints, including the knee.
Doctors cant say for sure why gout flares occur more often at night but, according to a 2015 study, it might be because your body temperature goes down at night, which could make uric acid more likely to crystallize.
Although the pain of a gout attack is distinct, there may be other reasons for your knee pain you should be aware of.
Pseudogout
Your knee pain could be caused by buildup of different kinds of crystals called calcium pyrophosphate . Doctors can examine fluid in your inflamed knee to determine if the crystals are uric acid or calcium pyrophosphate.
When Hip Pain May Mean Arthritis
Learn about the various causes of hip pain, including different kinds of arthritis.
Many forms of arthritis and related conditions can cause pain, stiffness and swelling in the hips. Hip pain can occur on the outside or inside of the hip, the upper thigh or outer buttock. Here are some diseases that can affect the hips.
Osteoarthritis
Osteoarthritis is the most common form of arthritis. Also known as wear and tear arthritis, OA is a chronic condition caused by the breakdown of the cartilage, which cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub together, causing stiffness, pain and loss of movement and the formation of bony overgrowths . Pain from hip OA is often felt in the groin area and front of the thigh. Stiffness may be worst after periods of inactivity, and decreased range of motion may affect your ability to walk.
Rheumatoid Arthritis
Rheumatoid arthritis is a chronic inflammatory disease that occurs when the immune system doesnt work properly and attacks the joints . Hip involvement in RA is often signaled by pain, stiffness or swelling in the hips, thighs or groin area. RA usually affects the same joint on both sides of the body .
Juvenile Arthritis
Juvenile arthritis is the term used to describe joint and rheumatic diseases that affect children and teens 16 years and younger. There are several types of juvenile arthritis that cause hip joint pain and swelling.
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Gout A Complex And Painful Form Of Arthritis
In general, arthritis can be divided into two categories degenerative and inflammatory. Gout falls into this second category and occurs when uric acid builds up in your system, forming sharp, crystal-like structures in your joints.
Your body produces uric acid when it breaks down purines, and then your kidneys process the acid and excrete it through your urine. If you have higher-than-normal levels of uric acid or your kidneys dont process the substance properly, the extra uric acid can turn into urate crystals, which gather in certain joints, causing considerable pain and inflammation.
In most cases, these crystals collect in the large joint in your big toe, though they can accumulate in your knees and ankles, as well.
Gout typically comes and goes, creating very painful attacks. Men are three times more likely than women to develop gout, and there are other risk factors, which well discuss shortly.
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The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
Steroids
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How Does Gout Affect The Feet
There are more than 100 different types of arthritis, but they all boil down to one thing joint pain and inflammation. In this regard, gout is no different, but its unique in that it can cause stabbing pain in your feet and ankles during a flare-up.
The team of highly qualified musculoskeletal experts here at Western Orthopaedics has you covered from head to toe and toe is an appropriate usage here as gout most often strikes your big toe.
Heres a closer look at gout, how it affects your feet and ankles, and what we can do to manage the problem.
Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
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What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- dehydration
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
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Diagnosis Of Chronic Gouty Arthritis
Chronic gouty arthritis should be suspected in patients with persistent joint disease or subcutaneous or bony tophi. Plain x-rays of the 1st metatarsophalangeal joint or other affected joint may be useful. These x-rays may show punched-out lesions of subchondral bone with overhanging bony margins, most commonly in the 1st metatarsophalangeal joint lesions must be ⥠5 mm in diameter to be visible on x-ray. Joint space is typically preserved until very late in the course of disease. Synovial fluid findings from chronic effusions are usually diagnostic.
Diagnostic ultrasonography is increasingly used to detect a typical double-contour sign suggesting urate crystal deposition, but sensitivity is operator-dependent and differentiation from calcium pyrophosphate crystal deposits may be more difficult to do conclusively.
Lets Talk More About Tophi
Sometimes, after repeated severe gout attacks, uric acid crystals collect beneath the skin and form small white or yellow lumps called tophi. They are typically found in soft tissue around the affected joints on the elbow or on the exterior part of the ear. Fortunately, tophi can be dissolved with treatment. When left untreated, they can gradually destruct bones and cartilage, leading to discomfort and immobility.
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How Can I Prevent Septic Arthritis
While not all cases of septic arthritis are preventable, there are a few things you can do to try to prevent getting it, including:
- Make sure cuts and wounds dont get infected: If you have a cut or wound on your skin, keep it clean to prevent infection. If you are experiencing signs of an infection such as redness, warmth and/or pus in or around your wound contact your healthcare provider immediately.
- Try to manage your chronic health condition well: If you have a chronic health condition such as diabetes or AIDS , try to manage your condition as well as you can in order to stay healthy.
- Practice safe sex: Always follow safe sex practices, such as always using a condom or dental dam and talking with your sexual partner about past partners and STI history.
- Dont abuse drugs: Injection drug use can cause infections. Only take medications as prescribed by your healthcare provider.
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Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
- Obesity, or a lot of extra weight.
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins
- Consume a significant amount of alcohol
- Are on water pills .
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Gout Frequently Flares In Your Knee But You May Not Always Know That Your Knee Pain Is Due To Gout Heres How To Tell Since Prompt Treatment Can Reduce Your Risk Of Complications
Knee pain can be a common symptom of several types of arthritis, as well as many other conditions or injuries. If your knee stiffness is accompanied by a burning pain and is warm to touch, you may have a gout flare in the knee.
Though gout is most often associated with the big toe, gout tends to flare in areas that already have arthritis, says Robert Keenan, MD, a rheumatologist with Articularis Healthcare in Summerville, South Carolina. Although gout can strike in many different joints, as a general rule, gout works its way up the body. If its not treated, it works its way up from the big toe, through the ankle, to the knee, and then to the lower spine and so on.
Gout can affect both knees, but typically is felt more strongly in one knee say, where you may have arthritis wear-and-tear to begin with.
Learn more about what causes gout in the knee, as well as ways to treat the pain and prevent it in the future.
How Common Is Gout In The Knee
As a general rule of thumb, if left untreated, gout tends to work its way up the body, Dr. Keenan explains.
For example, he cites research that shows 50 percent of patients experience their first gout attack in the big toe. If gout worsens, 35 percent of secondary flares occur in the knee, 40 percent in the midfoot and ankle, 30 percent in elbows and wrists, and 15 percent in fingers.
Its not uncommon for a person to experience their first gout flare in their knee and, after an X-ray or ultrasound, show signs of gout in the foot, he adds.
Gout can afflict both knees, but typically is felt more strongly in one knee where arthritis from general wear is worse.
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Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:
Causes Of Gout In Your Shoulder
An excess of uric acid in your bloodstream is thought to trigger gout by forming needle-shaped crystals that build up in your tissues and joints. Excess uric acid is technically known as hyperuricemia.
Uric acid is a waste product produced by the breakdown of purines, chemical compounds naturally present in your body. Uric acid is also produced when you digest foods containing purines.
Normally your kidneys remove uric acid waste via your urine. If your kidneys arent functioning properly, uric acid levels can build up in your bloodstream.
The crystals that form from this excess uric acid are attacked by your immune system as foreign bodies. Infection-fighting cells go to the area of the crystals, causing inflammation.
A of gout reports that only 10 percent of cases are caused by your bodys increased production of uric acid. The other 90 percent are caused by the failure of the kidneys to eliminate enough uric acid.
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How Will Gout Affect Me
Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.
Without medication attacks tend to happen more often and other joints can become affected.
Having high urate levels and gout for a long time can lead to other health problems, including:
- narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks or other heart problems
- osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
- an increased risk of developing kidney disease or worsening of the condition if you already have it
- kidney stones
- an increased risk of some cancers, especially prostate cancer
- mental health problems, including depression
- underactive thyroid
- erectile dysfunction in men.
If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.
Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:
- treating the acute attack
- treatments to prevent future attacks.
The No1 Activity Thats Making You Weaker Fatter And Is Killing Your Sex Life
It may be the most harmless activity known to man, but itâs also one of the biggest dangers to your health.
Even if youâre the most active of athletes, you may still suffer from a tight psoas due to the amount of time you spend each day planted to a chair.
Weakness, shortening and tightness develops in the muscle through sitting for extended periods of time, poor sleep posture and even stress and tension.
Here are 3 ways that sitting is killing your physical and emotional health:
Bulging belly syndrome
Wonder why your stomach still sticks out even though youre hammering the core exercises every day? Itâs a common myth that bulging belly is due to weak abdominal muscles. The real cause is likely to be tight psoas muscles, which cause the lower back to curve pushing out the stomach. When the psoas works properly it pulls the abdomen back tucking the tummy in, giving you a strong, flat stomach.
Fat loss inhibitor
Lack of sexual performance
Sitting all day causes your hips to become stuck in a forward thrust position. This leads to pulling on the lower back and decreased blood flow and circulation through the hips and to where it matters.
Sitting is your enemy in the quest to discover peak health, because of the wide-ranging impact it causes to your most vital muscle.
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