Gout Knee - Symptoms, Pictures, and Treatment

Gouty arthritis is a disease of metabolism characterized by monosodium urate crystals in the joints and surrounding soft tissues. This arthritic disorder causes symptoms of pain, swelling, and inflammation in the knee joint, and may extend to the leg.

Gout is caused by a defect in metabolism or breakdown of purines, resulting in excessive uric acid in the blood, caused by the kidney's inability to excrete uric acid normally. People with chronic conditions, such as diabetes, sickle cell anemia, and kidney disease, are at high risk for development of gout. Obesity is also a risk factor for gout.

The disorder occurs in 4 stages: asymptomatic (without symptoms), acute, intercritical, and chronic.

The onset of acute gouty arthritis of the knee develop suddenly and frequently begins at night, and is excruciatingly painful. The knee joint appears to be infected with signs of warmth, redness, and tenderness.

The painful attack of the knee joint may disappear within several days, but may return at irregular intervals with a longer duration, or may never return at all.

Common risks include:

Men
Postmenopausal women
Use of alcohol
Being overweight

Joints of attack include:

Hips
Knees
Ankles
Feet
Shoulders
Elbows
Wrists
Hands

The great toe (podagra), knee, or ankle joints are most often affected, and can be accompanied by swelling, stiffness, warmth, and redness.

Tophi: Is the accumulation of urate crystals in the soft tissue, appearing as lumps, surrounding the affected joint, and may drain a chalky material.

Diagnosis:

Physical assessment of the knee joint may show acute arthritis. Examination of the synovial fluid from the inflamed joint will show urate crystals. Hyperuricemia (high uric acid level) will also be evident in blood samples. X-rays may be normal.

Tests include:

• Uric acid - urine


• Synovial biopsy


• CBC and differential

Treatment:

The goal of treatment is to eradicate the pain, as well as the inflammation. In addition to this, the prevention of future attacks is essential.

Colchicine: Reduces pain, swelling, and inflammation. Successful pain management occurs within 12 hours of initiating treatment, with total relief in two days. However, colchicine does not decrease uric acid levels in the blood, but used in conjunction with allopurinol helps to avoid future attacks.

NSAIDs (non steroidal anti inflammatory drugs) are effective for management of pain and inflammation. .
Corticosteroids injected into the inflamed joint is also effective for pain management.
Codeine or other analgesics may be prescribed to reduce pain.

Attacks of gout of the knee can progress to a more chronic condition. Left untreated to prevent future attacks, gout may return for a longer period of time and may also cause damage to the joints. It is important to drink adequate amounts of water daily to prevent the formation of uric acid kidney stones.

by Barb Hicks, RN