Pain > Gout Knee Physiotherapy
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.
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
- big toe
- ankles and
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
- red and
- 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
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
- 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.
In fact, approximately 50% of people with gout do NOT have
- hyperuricemia or
- high uric acid levels
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
Gout knee symptoms usually start at night due to lower body
temperatures. The affected knee joint will very quickly becomes
- 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
Gout knee can make weight bearing
activities such as walking and going up and down stairs incredibly painful.
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
They can then confirm the
diagnosis of gout by doing
- blood tests (although these can be unreliable) or
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:
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.
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
Steroids, either taken orally or via an injection, can help to reduce the inflammation and pain associated with gout knee.
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
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
- sudden and
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
increase in life expectancy
- dietary changes and
- an increase in gout-associated
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
- 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:
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