What Causes Gout In The Knee
Gout develops when the body has high levels of uric acid, a normal waste product. This is known as hyperuricemia.
Uric acid is normally excreted through the body via the kidneys, but in some people, levels can remain high and uric acid can start to accumulate and crystallize in various joints. When these uric acid crystals affect the joint in the knee, it can cause gout symptoms in the knee, making the knee joint red, swollen, and hot to the touch. The buildup of uric acid can also impair the knee joints full range of motion, which can make it difficult to walk.
A number of factors can influence your risk for gout.
How Can I Prevent Gout
If gout runs in your family, men in particular should limit alcohol, fats, and foods that are more likely to increase uric acid level in the body. Those include meat, sardines, bacon, mussels, and yeast. Beer, especially, can also bring on a gout attack. Drinking plenty of liquids may help minimize the risk of kidney stones. Your doctor can do blood and urine tests to figure out your potential risk of a gout attack. Itâs also a good idea for men who are at greater risk to keep an eye on their weight.
Medications can also help prevent gout attacks if you have them often. These drugs decrease the production of uric acid or increase the amount of uric acid you get rid of in urine. These medicines include allopurinol , colchicine , pegloticase , probenecid , and rasburicase .
If these medications arenât effective, your doctor may prescribe . If you have heart issues, be very cautious taking febuxostat.
Choose The Right Footwear
Because gout often affects the big toe, midfoot, and ankle, choosing good footwear is important. Dr. Iversen says a physical therapist can help evaluate the best footwear for a patient with gout based on evidence that shows specialized footwear provides benefits for patients by changing the alignment of the leg and foot, influencing the activity of the muscles of the foot, and your gait pattern . These modifications are designed to decrease the pressure on your joints.
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Risk Factors For Gout
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 knee gout symptoms.
In fact, approximately 50% of people with gout do NOT have hyperuricemia, high uric acid levels.
There are a number of other factors that increase your risk of developing gout knee pain:
- Genetics: there is thought to be a genetic link inabout 20% of cases
- Age: most commonly affects people over 40 with the peakincidence at 75
- Obesity: especially rapid weight gain. A BMI greater than 35 increases the risk three times
- Diet: accounts for approximately 12% of cases. Risk factors include excessive alcohol intakeespecially binge drinking, fructose-based drinks and seafood
- Medical Conditions: Kidney disease and/or metabolism problems
- Drug Treatments: mostcommonly diuretics used to treat high blood pressure,heart failure and oedema
- Trauma: gout knee may develop after an injury or surgery
Gout knee can develop any time after puberty, although in women, ittends to be after the menopause. This is thought to be due to the positiveeffect of oestrogen until then.
Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
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Causes Of Gout In Fingers
Gout attacks in fingers are more common in older people because they have chronic uric acid build-up. Gout in fingers is most commonly seen in post-menopause older women. Uric acid is a waste product formed by the metabolism of purines. Excessive uric acid is processed in the kidneys and passed out of the body in the urine.
When uric acid levels increase beyond the capacity of kidneys to eliminate them from the body, uric acid starts to accumulate and crystallize in the tissues, particularly in and around the joints, which results in pain and swelling in the joint. These crystals are more probably formed at cooler body temperature. Thats why gout is more common in toes and fingers.
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Which Is Better For Gout Prednisone Or Colchicine
Prednisone is excellent for killing gout inflammation and pain. I have tried colchicine and had no relief, but prednisone works within hours. One or two doses is usually enough if taken at first sign of pain. The only side effect is it sends sugar readings high for a day or perhaps two if you need to continue taking it.
Your immune system reacts by sending infection-fighting cells to the area, causing inflammation. Gout attacks tend to be sporadic and may affect more than one joint. Gout can usually be managed with diet and medication.
Prednisone is one of the drugs used to treat gout 2 3 4. Is This an Emergency? If you are experiencing serious medical symptoms, seek emergency treatment immediately. Consult your medical doctor or health-care provider to determine if taking prednisone is an option 2 3 4.
Can Gout Be Cured Permanently
The answer to this is yes and no. Some people are luck to only have one or two episodes of gout that settle quickly with treatment, never to return.
However, in many cases, gout is a long-term condition that needs to be managed, such as asthma or hay fever. Treatment to keep uric acid levels low such as colchicine, and dietary regimes may be necessary long-term to prevent further attacks of gout knee pain.
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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.
Foods To Limit Or Avoid
Cutting out or limiting foods that contain purines may help further reduce the amount of uric acid in the bloodstream and the risk of developing gout or experiencing gout flare-ups in the future.
Some foods rich in purines are the following:
- alcohol, especially beer and spirits
- certain meats, such as turkey, bacon, veal, liver, venison, and organ meats
- some types of fish and seafood, such as haddock, trout, scallops, cod, mussels, anchovies, sardines, and herring
Foods moderately high in purines include:
- avoiding extreme diets, especially diets low in carbohydrates and high in proteins
- eating a healthy diet that reduces the risk of diabetes, high blood pressure, and obesity, such as one that includes a lot of fruits, vegetables, nuts, and plant proteins
People with joint damage or tophi from gout may require surgery.
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How Is Gout In The Ankle Diagnosed
If you think you might have gout but havent been diagnosed, try to see a doctor while youre having symptoms. Gout is easier to diagnose when youre in the middle of a flare-up thats causing swelling, redness, and other visible symptoms.
During your appointment, your doctor will likely ask you several questions about your diet, any medications you take, and whether you have a family history of gout. This can help to rule out other potential causes of your symptoms, including an infection or rheumatoid arthritis.
Your doctor may also order a blood test to check your uric acid levels. But some people have high levels of uric acid and dont develop gout. Others have typical uric acid levels but still develop gout. As a result, theyll want to do some other tests as well.
An X-ray, MRI, or CT scan of your ankle can also help to eliminate other possible causes of joint inflammation. Depending on your exam, they may also order an ultrasound to check for the presence of crystals in your ankle.
Finally, they might do a joint fluid test. This involves taking a small sample of joint fluid from your ankle with a small needle and looking at it under a microscope for any uric acid crystals.
Based on the results of your exam and tests, they may refer you to an inflammatory arthritis specialist called a rheumatologist for treatment.
Theres no cure for gout, but a combination of medications and home treatments can help to manage ankle pain and reduce the number of flare-ups you have.
Gout In Shoulder: Can Gout Affect Your Shoulder
For many people, the first symptom of gout is unbearable pain and swelling in the big toe which often occurs after a trauma, such as an illness or injury. Later attacks may occur in other joints, typically the feet, ankles, knees, hands, wrists, and elbows.
Attack on shoulder is less common but can happen.
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How Common Is Spinal Gout
Gout in the spine is extremely rare. A study published in 2016 in the European Spine Journal found only 131 cases described in medical journals. But Theodore Fields, MD, a rheumatologist at The Hospital for Special Surgery in New York City, says its more common than we think.
Some early studies suggest there is more gout in the spine that we previously thought. Most doctors just arent looking for it, he says. Patients with spinal gout usually have a previous history of gout in other places.
Gout typically affects the big toe joint and other extremities first, including the knees and tips of the fingers. People often describe an attack of gout as being so painful they are unable to put on a shoe or drive to the hospital. However, Dr. Fields says it is certainly possible that someone could present with back pain as an initial symptom.
Gout can travel to almost any joint over time, says Dr. Fields. If someone has untreated gout for 10 to 20 years, it is not rare to get it in their fingers, wrists, cervical and lumbar joints, and even occasionally the elbows. The only place it is really rare to get gout is in the hip.
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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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.
Are There Treatments For Gout In The Knee
Yes, and were eager to share them with you. We offer diverse treatments that have given our patients long-term relief for their knee gout pain and movement issues.
First, we talk about things you can do at home, like icing your knee or using heat on it. We also recommend and teach you how to do healing exercises that help restore function to your knee and minimize discomfort.
We also offer in-office manual physical therapy, stretching regimens, and exercises that complement the ones you do at home to hasten your healing, but we make sure healing is smartly paced. Were proud to offer state-of-the-art rehabilitative equipment right here in our office.
We create a program based on the activities you do routinely. After you heal, we want you to enjoy the activities you did before and perform routine daily movements, free of pain.
An innovative treatment we offer for knee pain is electrophysiological stimulation, or e-stim. This treatment involves sending an electrical current to your targeted treatment area, which:
- Treats inflammation effectively
- Strengthens muscles and improves their functioning
- Reduces pain
In addition to treating your knee pain, we make recommendations about how to keep gout at bay, which include losing weight if necessary, avoiding foods and beverages that are high in purines, like red meat, shellfish, and beer, and changing certain medications.
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How Gout Can Affect Your Vision
Although eye complications related to gout are uncommon, long-term gout can cause uric acid to build in eye tissue and has been linked to cataracts and dry eye. Cataracts are a clouding of the lens in your eye, which is normally clear. When cataracts develop, vision becomes foggy. Dry eye is diagnosed when your eyes stop making enough tears or dont produce good quality tears, and your eyes become red and irritated.
Why Does Gout Target The First Metatarsophalangeal Joint
The studies discussed above provide clear evidence of an association between MSU crystal deposition and OA. Whilst further studies are required to definitively answer the questions of direction of association and causality, it appears that MSU crystals more readily deposit in osteoarthritic cartilage and that the presence of OA influences the distribution of joints affected by gout. However, OA cannot solely explain the typical distribution of joints affected by gout, as many joints commonly affected by OA such as the knees, finger IP joints, and hips are less frequently affected by gout than the first MTPJ, and other target joints for gout such as the ankle, wrist and elbow are infrequent sites for primary OA. Is it plausible therefore that the relationship between MSU crystal deposition and OA is of more relevance for the first MTPJ than other joint sites?
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How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout