How To Prevent Knee Gout
A general rule in medicine is that prevention is the best form of treatment, as never developing the condition through proper preventive measures will save you from distress as well as expensive medical bills. The following are recommendations to follow to prevent the development of gout:
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Mohan Garikiparithi got his degree in medicine from Osmania University . He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine , and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.
Do I Have Gout What Are The Symptoms
This is one of the questions that we get most from the people visiting GoutBye! The very early symptoms may appear before any gout flares. A sign of gout might be the elevated uric acid levels or purine levels that might appear in your regular blood test results. You can also take our free anonymous assessment test to define how likely you might have gout.
Most often, however, the people get alarmed when they experience the so-called gout flare:
- The flares often occur by night.
- Intense and constant pain in your big toe or another joint. Gout usually affects your big toes large joint, but it can also affect your fingers, ankles, knees, elbows, or wrists.
- Inflammation. The affected joint or joints show inflammation symptoms swollen, tender, warm, and red.
- The first four hours are usually the worst. The pain is really great in the first hours of the gout flare. On some occasions, you cant step on or even touch the foot.
- The flare lasts around 12 hours, but some joint discomfort may last from a few days to a few weeks after the severe pain subsides.
You can read on how you can handle an unexpected gout flare attack or if youre experiencing such for the first time.
Our mission at GoutBye is to help you build precisely these habits and make your life easier. Make sure you will check out other articles on our site.
What Is The Prognosis Of Pseudogout
The outlook of pseudogout is generally very good. Aggressive treatment of the inflammation can lead to complete resolution of the inflammation, pain, tenderness, and loss of joint function. While this can last for weeks, the inflammation of resolves within days with proper treatment.
Recurrent attacks of pseudogout and chronic joint inflammation can lead to injury to the affected cartilage and bone.
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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.
Gout Knee Pain Diagnosis
Your doctor can normally diagnose gout knee by from what youtell him about your symptoms and your history such as any risk factors orprevious episodes.
He can confirm thediagnosis of gout by doing blood tests, although these can be unreliable, or byremoving a small amount of fluid from the knee joint, known as aspiration.
The fluid is examined under a microscope,looking for the presence of excessive uric acid crystals. Kidney function tests may also be done to confirm the diagnosis of gout knee.
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How Can I Self
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. If youve been diagnosed with gout, youll benefit in the long term from making healthy changes to your lifestyle, such as:
- maintaining a healthy body weight. If you do need to lose weight, make sure your weight loss is gradual as crash diets can increase uric acid levels
- drinking alcohol in moderation and avoiding binge drinking
- drinking plenty of water, and staying hydrated
- avoiding, or eating in moderation, foods that are high in purines. Talk with a dietitian for tips and advice
- exercising regularly aim to complete at least 30 minutes of physical activity most days of the week
- working closely with your GP to prevent further attacks and actively manage your condition.
What Are The Risk Factors For Gout
Risk factors for gout include:
- being male
- taking medications that increase water excretion by the kidneys
- being overweight
- eating a diet with a lot of meat, offal and shellfish
- having kidney disease, high blood pressure, diabetes or abnormal levels of fat and cholesterol in the blood
- drinking a lot of alcohol, especially beer, port or spirits
- going on a crash diet or fasting
- being of Maori or Pacific Islander origin, which can predispose a person to high uric acid levels
Gout is more common in men than in women, and among women it’s more common after menopause. It’s more likely to occur in older people, but can affect anyone.
It can also affect people with certain types of blood disorder and people in treatment for cancer.
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How Is Pseudogout Treated
The type of pseudogout treatment depends on several factors, including your age, other medications youâre taking, your overall health, your medical history, and how severe the attacks are. Drugs to treat pseudogout include:
- Anti-inflammatory painkiller drugs, also calledNSAIDs, generally are prescribed to treat sudden and severe pseudogout attacks. NSAIDs — like ibuprofen and naproxen — usually reduce inflammation and pain within hours.
- Corticosteroids may be prescribed if you canât take NSAIDs. Steroids also work by decreasing inflammation. They can be injected into the affected joint or given as pills.
- Colchicine, a gout drug, is sometimes used in low doses for a longer period of time to reduce the risk of repeated attacks of pseudogout.
Anti-inflammatory medications are usually continued until the pseudogout attack goes away. Symptoms are often better within 24 hours after treatment begins.
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Gout Knee Recovery Time
A common question with gout in knee is how long does it last? Most cases of gout knee are acute, sudden and short-lived. Left untreated, most episodes of gout knee settle down after a couple of weeks.
Unfortunately, repeat episodes are common and most people will suffer a recurrence of gout knee pain anywhere from 6 months to 2 years later. 60% of gout sufferers will have a recurrence within 1 year.
Are The Any Possible Complications?
Sometimes, gout spreads from the knee and affects more than one joint at a time, such as the big toe or hands.
There is also a risk of the uric acid causing crystals to form in the kidneys which can lead to inflammation, scarring and kidney stones.
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What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
Reduced Range Of Motion
Whether youre having an attack or have endured permanent damage, your joints will not fully function. Due to inflammation or damage, your range of motion may be hindered. This means that both the distance and direction that a joint can move, will essentially decrease. This is especially common within ones knee joints, however, some simple exercises can help prevent stiffness. If youre experiencing inflamed joints, its best to seek advice from your physician. Its important to remain active, reducing the possibility of overly stiff joints.
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What Can I Do About It
The good news is that gout is now very treatable. There are several medicines that can be deployed when it strikes the main ones are colchicine and non-steroidal anti-inflammatory drugs . A longer-term preventative medicine is allopurinol, which works by lowering the level of uric acid in the blood. We sometimes also recommend a steroid injection to the knee joint, or aspiration to relieve swelling and pressure.
Lifestyle changes can make a difference too. The NHS has a useful list of recommendations for preventing gout from recurring:
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.
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How Are Gout Attacks Prevented
Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.
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.
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How Is Gout Diagnosed
Gout is diagnosed using a number of tests including:
- medical history
- physical examination
- blood test to measure urate levels although this cannot confirm gout
- removing a sample of fluid from the joint if you have gout, uric acid crystals can be seen under a microscope. This is the most definitive test
- ultrasound scan can identify early crystal formation in the fluid between your joints.
Early diagnosis and treatment is very important. The main goal for everyday management of gout is to reduce the level of uric acid in your blood so it cant form crystals in the tissues or joints and cause joint damage.
Gout In The Knee: Telltale Signs
Knee gouts distinct symptoms include:
- Inflammation in and around the knee joint
- A warm or hot feeling in the knee
- Skin reddening or shininess
- Skin flaking and itching when inflammation subsides
- Extreme pain and sensitivity
Because gout pain in your knee can be so severe, you may not be able to tolerate the slightest touch or put any weight on your knee.
Gout attacks known as flares come suddenly and can even wake you in the middle of the night. These can last anywhere from a few days to over a week.
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What Foods Get Rid Of Gout
There are a number of different foods that are thought to help get rid of gout knee.
- Cherries: There have been a few studies published that suggest cherries can be helpful in treating and preventing gout knee pain. It is thought that the anthocyacins cherries contain help reduce uric acid levels and inflammation. A study published in 2012 showed that gout sufferers who ate at least 10 cherries a day avoided recurrent attacks.
- Dairy Products: Low-fat dairy products such as milk, yogurt and cheese can help to reduce uric acid levels in the blood. It is thought that the combination of being high in protein and low in purine levels is what makes dairy products useful in preventing gout knee pain.
- Coffee: a number of large studies have shown the benefits of drinking coffee, regular or decaffeinated, to prevent gout. One study, looking at over 45,000 people, found that those who drank 4 or 5 cups of coffee a day were 40% less likely to develop gout.
- Water: Keeping well hydrated has also been shown to reduce the risk of recurrent gout attacks as it is linked with lower levels of or hyperuricemia.
- Vitamin C: High doses, 500mg, of vitamin C can help to reduce uric acid levels. Always check with your doctor whether vitamin C could help you before taking it to reduce your gout knee pain
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
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What Causes Gout Knee
Gout knee pain is caused by high levels of uric acid, aka urate, in the blood.
Uric acid is a waste product of many food sources. It normally passes out in our urine, but with gout knee there is a problem with how the body metabolizes, or breaks down, the uric acid.
This can either lead to:
- thekidneys not passing urate quickly enough – 90% of cases
- the bodyproduces too much urate – causing less than 10% of cases
If the level of uric acid is too high, crystals can form inyour soft tissues, usually around one joint such as the knee, resulting in gout.
The crystals cause an inflammatory response in the tissues leading tohot, swollen, red and painful joints. Thecrystals tend to form at cool temperatures, which is why gout is so common inthe hands and feet.
Uric acid levels areoften raised for a number of years before gout knee symptoms develop.
Common Gout Knee Symptoms
In most cases, the symptoms of gout in knee develop rapidly over a few hours.
Common gout knee symptoms include:
- Pain & Swelling: The knee joint quickly becomes hot, swollen and red and usually becomes extremely sore
- Night-Time Onset: Gout knee symptoms usually start at night due to lower body temperatures
- Skin Changes: the skin around the knee joint often looks shiny and there may be small, firm lumps under the skin, known as trophi
- Fever: Sometimes, gout results in a raised body temperature
- Reduced Function: Gout knee often makes weight-bearing activities such as walking and going up and down stairs incredibly painful
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