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Gout Knee Physiotherapy

Gout knee refers specificly to an inflammatory condition characterised by very intense pain and swelling of and within the knee joint. 

You know what, gout is a fairly common condition affecting approximately 1 to 2 percent of the general population, which means that gout affects at least one million Americans each year. The rate of gout occurrences is also increasing in Singapore too, due to the increase of consumption of meat and beer.

Statistically, men are around 2 - 3 times more likely to be diagnosed with gout as compared to women and the peak age of gout diagnosis and incidence is 75 years old. 

Unfortunately, gout flare ups are often extremely painful and recurrent episodes are common (that means that the flare ups can happen quite regularly).

As well as affecting the knee, gout can also affect the

• foot
• big toe
• hands
• toes
• ankles and
  
• wrists

Fortunately, gouty flare ups tends to only affect one joint at a time rather than being global or widespread. If patients experience their knee suddenly becoming

• hot
• painful
• red and
  
• swollen

- it is most likely due to gout knee.

first of all, What Causes Gout Knee?

Gout knee pain develops when there are high levels of uric acid (also known as "urate") in our blood and system. Uric acid refers to a waste product of many food sources. It typically exits our system via our urine, but sometimes there is a problem with how the body metabolises (breaks down) the uric acid, that can either lead to

• the kidneys not passing uric acid quickly enough (90% of gout cases is due to this) or
  
• your body produces too much uric acid (10% of gout cases is due to this)

If the level of uric acid is too high, uric acid crystals can form in your soft tissues, which can then travel around and can lodge or damage a joint.

That joint can be the knee, and that's called gouty knee. These uric acid crystals cause an inflammatory response in the tissues leading to

• hot
• swollen
• red and
  
• painful joints

One this research notes is that these uric acid crystals tend to form at cool temperatures, which explains why gout attacks and flare ups is more common in the extremities of hands and feet (which is typically cooler as it's further away from the central body and heart).

Uric acid levels are often raised for a number of years before gout knee symptoms develop.

question is, Who Is Most At Risk Of Gout?

Some people are more susceptible to gout than others and sometimes unfortunately there is little to no correlation between the levels of uric acid in the blood and knee gout symptoms.

There are a number of other factors that can predispose you to gout knee pain:

• Genetics: about 20% of cases is linked to genetics and family history
  
• Age: typically affects people over 40 years age with the peak incidence at 75
  
• Obesity: especially with rapid weight gain. A BMI greater than 35 increases the risk three times (300%!)
  
• Diet: accounts for approximately 12% of cases. Risk factors include excessive alcohol intake especially binge drinking, fructose-based drinks, red meat and seafood
  
• Medical Conditions: Kidney disease and/or metabolism problems
  
• Drug Treatments: most commonly diuretics (known as water tablets) used to treat high blood pressure, heart failure and oedema
  
• Trauma: gout knee may develop after an injury or surgery

In some cases, gout knee can also develop any time after puberty, although in women, it tends to be moreso after menopause (so moreso above 50+ years of age). Researchers think that this is due to the positive effect of oestrogen until then.

Gout Knee Symptoms

In most cases, the symptoms of gout in knee develop quickly and rapidly over a few hours. 

Gout knee symptoms usually start at night due to lower body temperatures. The affected knee joint will very quickly becomes

• hot
• swollen
  
• red and
  
• usually becomes extremely sore

With gout knee swelling, the skin around the joint can swell to the portion that it looks shiny and there may be small, firm lumps under the skin, known as trophi. Sometimes, gout can also cause a fever (increased body temperature).

Gout Knee Pain Diagnosis

Your doctor can normally diagnose gout knee by from what you tell him or her about your painful knee symptoms as well as your history such as any risk factors or previous episodes.

They can then confirm the diagnosis of gout by doing

• blood tests (although these can be unreliable) or
  
• by removing 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.

Knee Gout Treatment

Left untreated, gout in knee episodes usually settle in a couple of weeks but in some cases they may last longer. Fortunately, there are a couple of things you can do to help speed up the healing process and prevent further attacks of gout knee:

1) NSAIDS

Non-steroidal anti-inflammatory medications such as ibuprofen / naproxen can work really well if taken as soon as gout symptoms develop. Please always check with your doctor before taking any new or even old medications.

2) Rest

If you are suffering from gout in your knee or knee pain, it is very important to rest. Elevate your leg to help reduce swelling, and avoid strenuous activity, e.g. limit weight bearing activities

3) Steroids

Steroids, either taken orally or via an injection, can help to reduce the inflammation and pain associated with gout knee.

4) Supplements

Some patients are prescribed gout supplements which may help to dramatically reduce both the frequency and intensity of flare-ups of gout.

5) Ice / Cold Therapy

Using cold therapy to cool down the joint can help reduce gout pain and swelling.

Gout Knee Recovery Time

A common question with gout in knee is how long does it last? ie when will the pain from gout knee flare up go away?

Good news is that most cases of gout knee are

• acute
• sudden and
  
• short-lived

Even when left untreated "to heal naturally", most episodes of gout knee settle down after a couple of weeks.

But bad news is that 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 =(

Gout Knee Prevention

The incidence of gout has doubled over the last 20 years and will likely also continue the upwards trend. Scientists and researchers are agreeing that gout occurrence increase to be due to

1. the increase in life expectancy
2. dietary changes and
   
3. an increase in gout-associated diseases
   

There are a number of things you can do to help with gout prevention:

• Avoid Excessive Alcohol Intake: alcohol can increase uric acid levels especially beer, stout and fortified wines
• Lose Excessive Weight: obese people are more likely to suffer from gout - discuss weight loss with your doctor, and also with us! We have weight management program that ties in with pilates, dietitian, personal trainers and physiotherapists to help you lose weight
  
• Avoid Fructose-Sweetened Drinks: such as soda
• Avoid Purine Rich Food: e.g. oily fish, offal, pulses and certain vegetables e.g. asparagus and spinach.
  
• See your doctor regularly: See and consult your doctor regularly to review your regular medications in case any of them may be causing or aggravating you to get or worsen your gout. For example, Allopurinol inhibits the formation of urate, probenecid increases its excretion by the kidneys 
• Supplements: There are a number of different supplements on the market that claim to lower uric acid levels and many gout sufferers swear by them. One study showed that an intake of 1,500mg per day of Vitamin C decreases the risk of gout by 45%. Of course, please always check with your doctor before starting any gout supplements 
• Drink Plenty of Water: to prevent dehydration. Aim for at least 1.2L (litres) of water daily

gout knee physiotherapy

Patients may also receive the following physiotherapy treatment modalities:

• cold therapy
• moist heat paraffin wax therapy
• radio-frequency Indiba physiotherapy to accelerate soft tissue healing
• joint mobilization
• stretching exercises
• strengthening exercises
• scar management
• hands on manipulation and mobilization (manual therapy)
• soft tissue management
• heat therapy and heat treatment and heat pack to relief tight muscles and joints
• ultrasound therapy to accelerate soft tissue healing
• exercise therapy
• acupuncture and/or dry needling
• deep tissue release
• and more