Gout in the Knee: Managing Pain and Limiting Flares

Aubrey Bailey, PT, DPT, CHT
·6 min read

Medically reviewed by Marissa Sansone, MD

Gout is a type of inflammatory arthritis that develops when high uric acid levels in the body form urate crystals in joints and other structures. This condition most commonly affects the big toe and knee joints. Gout symptoms come and go. Periods of increased symptoms are called flare-ups or gout attacks.

This article discusses gout in the knees—how it feels, its causes and triggers, how it is diagnosed, treatment options, and possible complications.

The Good Brigade / Getty Images
The Good Brigade / Getty Images

Symptoms: How Gout Knee Pain Feels

The primary symptom of knee gout is severe pain, often starting at night. Symptoms of gout can include the following:

  • Chills

  • Difficulty walking

  • Fever

  • Redness in the affected area

  • Shiny skin

  • Skin that is warm to the touch

  • Stiffness or difficulty bending or straightening the knee

  • Swelling around the knee

Gout flare-ups in the knee can last for days or weeks. Typically, the pain is at its worst within the first 24 hours of onset. Flare-ups can occur frequently or might be years apart.

Causes and Knee Gout Triggers

Gout is caused by too much uric acid in the body. Uric acid forms when substances called purines are broken down in the body. Purines are naturally present in cells throughout the body. Higher levels of purines also are present in certain foods and beverages, such as:

  • Alcohol (e.g., beer, liquor, wine)

  • Certain meats (e.g., beef, lamb, pork)

  • Certain seafood (e.g., shrimp, tuna)

  • Other cooked/processed animal or seafood products

  • Sugary drinks

Consuming high amounts of these foods and beverages increases your risk of gout. Beer contributes more significantly to gout risk than other alcoholic beverages.

Other potential risk factors for gout are:



Plant-Based Purines and Dairy

High levels of purines are also found in dairy products and plant-based foods—such as mushrooms, legumes, peas, and beans—but eating these foods has not been linked to an increased risk of gout.



How to Get Gout in Knee Diagnosed

A healthcare provider begins the process of diagnosing gout with a physical exam. This can include a review of your symptoms, a visual inspection of the knee, palpation (gentle touching), and assessment of movement in the knee.

Other tests can include:

  • Blood tests to assess levels of uric acid

  • Joint aspiration (taking a sample of fluid from the knee to assess levels of uric acid)

  • Imaging, such as X-rays or magnetic resonance imaging (MRI)

You might also be referred to a rheumatologist—a doctor who specializes in diagnosing and treating gout, as well as other inflammatory and arthritic conditions.



Differential Diagnosis of Gout

Symptoms of gout in the knee can be similar to other medical conditions, such as:



Related: Gout vs. Rheumatoid Arthritis: What Are the Differences?

Knee Gout Treatment Options

Providers typically treat knee gout with nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclo-oxygenase-2 (COX-2) inhibitors. which include:

  • Celebrex (celecoxib)

  • Clinoril (sulindac)

  • Indocin (indomethacin)

Healthy lifestyle habits, such as following a gout diet to lower purine levels, can also help reduce uric acid in your body and decrease gout symptoms in the knee.

Medications are often prescribed to help lower uric acid levels in the body. These can include:

  • Xanthine oxidase inhibitors (decreases the production of urate)

  • Uricase (breaks down urate to make it easier for the body to flush it out)

  • Uricosuric agents (increase amount of urate that is flushed out of the body by the kidneys)

Related: How to Quickly Relieve Gout Pain

Home Remedies and Self-Care

Home remedies and self-care can help control your symptoms during a knee gout flare-up.

They include:

  • Apply ice: Apply ice to your knee several times each day during a gout flare for 20 to 30 minutes at a time. Place a cloth between the ice pack and your skin to avoid ice burn.

  • Avoid aggravating activities: Rest your knee, and avoid any activities that worsen your pain.

  • Elevate your leg: Prop your leg on some pillows when you're lying down to help reduce swelling.

  • Hydrate: Drink lots of fluids (preferably water) to help flush excess uric acid out of your body. Avoid alcoholic beverages.

  • Maintain range of motion: Slowly bend and straighten your knee 10 times in a pain-free range of motion. Do this several times per day to help maintain your mobility.

  • Reduce your stress: Stress can increase gout symptoms. Practice relaxation and stress management techniques throughout the day.

  • Relieve some pressure: Use a cane to help reduce pressure on your knee while walking during a gout flare. Hold the cane in the hand on the opposite side of the painful knee.

  • Take a seat: Avoid standing on your affected leg for long periods.

Complications and Long-Term Effects of Gout in Knee

Complications can occur from gout in the knee, mainly if left untreated. Uric acid crystals can accumulate under the skin and form lumps called "tophi."

Chronic (long-term) gout can cause knee joints to become deformed, leading to constant pain and limited mobility or osteoarthritis.

Severe joint damage can require total knee replacement surgery. People with chronic gout are also at higher risk for kidney stones and kidney disease.

How to Reduce Gout in Knee Flares

Lifestyle modifications can reduce the risk of gout in knee flares. These include:

  • Avoid alcohol.

  • Avoid foods high in purines.

  • Drink lots of water.

  • Exercise regularly.

  • Maintain a healthy weight.

  • Take medications as prescribed.

When to See a Healthcare Provider for Gout in Knee

If you develop new or worsening gout symptoms, follow up with a healthcare provider. If you're having difficulty moving your knee or walking, consider seeing a physical therapist for exercises and recommendations for assistive devices, like a cane or walker.

Summary

Gout in the knee occurs when uric acid builds up in the body, causing crystals to form in the knee joint. Gout causes pain, redness, warmth, and swelling in the affected joint. It is diagnosed with a physical examination and other tests, such as blood work and joint aspiration. Left untreated, gout in the knee can lead to permanent joint damage.

Medications are the primary treatment for gout. Home remedies, such as ice and rest, can help reduce gout symptoms in the knee. Eating a diet of low-purine foods and maintaining a healthy weight can decrease your risk of further gout flare-ups.

Read the original article on Verywell Health.