Gout in the knee: symptoms, causes, treatments, and exercises

Few things can bring you to your knees quite like the discomfort of gout in the knee. Gout, a type of inflammatory arthritis, happens when excess uric acid — a waste product from your body’s cells — builds up in your bloodstream. Typically, your kidneys use their filtering abilities to remove extra uric acid, but sometimes they can’t keep up. This allows uric acid to form tiny, needle-like crystals in joints or surrounding tissue, leading to inflammation and pain. 

While gout most often affects the foot and knee, earning it the nickname “the unwalkable disease,” it’s a manageable condition that doesn’t have to hold you back from daily life. “Once you’ve had gout, you’re more prone to additional flare-ups, but with the right treatment, gout can often be well-controlled,” says Jennifer Hayes, PT, DPT, a physical therapist at Hinge Health. 

Read on to learn more about gout in the knee and what you can do to prevent and treat it with tips and exercises from Hinge Health physical therapists.

Symptoms of gout in the knee

Gout is a common form of arthritis that can affect anyone, although it’s more likely to occur in men. “Unlike other forms of arthritis, gout is usually characterized by sudden, severe onsets of pain, swelling, and stiffness,” says Dr. Hayes. These episodes, known as gout attacks or flares, often happen at night and can be intense enough to wake you. This is because your body temperature naturally drops slightly at night, which can encourage uric acid crystals to form in the joint and trigger an attack.

The first gout flare typically affects a single joint, most commonly your big toe. However, gout can also begin in other joints, including your knee. Symptoms usually last three to 10 days and tend to improve each day as the flare resolves, says Dr. Hayes. When gout affects your knee, you may experience:

• Sharp pain

• Warmth to the touch

• Tenderness

• Swelling

• Stiffness and limited range of motion

• A shiny appearance to your skin, usually from the swelling

Gout can sometimes affect both knees, but it’s usually more pronounced in one knee. This is often the knee where you may already have another condition, such as osteoarthritis.

Causes of gout in the knee

Gout affects about four percent of American adults and is more common in men due to higher levels of uric acid, which can accumulate and crystallize in the joints. In women, gout typically occurs later in life, particularly after menopause, when uric acid levels rise as a result of decreased estrogen.

Several factors can increase your risk of developing gout in the knee. 

• Diet high in purines. Purines are natural compounds that break down into uric acid during digestion. Foods high in purines include certain seafood, meat, alcohol (especially beer), and sugar-sweetened beverages.

• Being overweight. Carrying extra weight increases the risk of gout because it raises uric acid production and makes it harder for your kidneys to eliminate uric acid effectively.

• Underlying health conditions. Conditions such as obesity, insulin resistance, high cholesterol, heart disease, and kidney disease are all linked to a higher risk of gout.

• Medications. Diuretics, often used to treat heart or kidney conditions, can contribute to higher uric acid levels by prompting the kidneys to produce more urine and work harder.

• Previous knee injuries. A past knee injury can increase your risk of gout in the knee. Injuries can lead to changes such as inflammation and cartilage loss, making the joint more susceptible to uric acid crystal deposits.

• Genetics. Family history plays a significant role — if gout runs in your family, your risk is higher.

Gout flares can be uncomfortable, but gentle movement can help you feel better. It improves circulation, reduces stiffness, and maintains muscle strength to support recovery. “It’s okay to scale back on activity if you need to on your first day of a gout flare,” says Dr. Hayes. “But after that, gentle movement can help ease your symptoms.” The above exercises are recommended by Hinge Health physical therapists to help you recover comfortably and safely. Dr. Hayes advises listening to your body and progressing exercises gradually. “Start with what feels manageable,” she says. “If you’re comfortable, try a little more — but always go at your own pace.”

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for gout in the knee

Gout flares can feel overwhelming, but early treatment can help you recover more comfortably and reduce the chances of future flares. While gout may eventually resolve on its own, addressing it early can help ease symptoms more quickly and support joint health. These conservative approaches can help alleviate symptoms of a gout flare in your knee. 

• Physical therapy. Working with a physical therapist can support recovery by providing targeted stretching and strengthening exercises to reduce inflammation, ease discomfort, and improve joint function and mobility. Promoting overall knee health can also make future gout flares feel less intense. “If you keep the muscles around your knee strong and flexible, it helps stabilize the joint and reduce pain,” says Dr. Hayes. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Ice. To help reduce swelling and ease pain, Dr. Hayes recommends using ice in combination with elevation. Prop your knee up with pillows so it’s above your chest, encouraging blood and fluid to flow away from the joint. Apply ice for 20 minutes at a time, then take a 20-minute break.

• Over-the-counter pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil) can help reduce milder pain and swelling, making it easier to stay mobile. Check with your primary care provider to make sure they’re safe for you based on your medical history, and follow dosage instructions to avoid potential side effects like stomach discomfort. For more severe pain, your doctor may recommend steroids, anti-inflammatory medications, or drugs to lower uric acid levels.

• Lifestyle changes. Diet plays an important role in managing gout. Limiting high-purine foods such as red meat, shellfish, alcohol, and sugary drinks can help reduce uric acid levels. Instead, focus on a diet rich in fruits, vegetables, whole grains, and lean proteins. Research shows that maintaining a healthy weight through balanced eating and regular movement can also lower your risk of future gout flares.

• Stress reduction. High stress levels can contribute to increased uric acid and worsen gout symptoms. Simple practices like deep breathing, mindfulness, or listening to relaxing music can help calm your nervous system, which may ease pain and discomfort.

PT tip: Avoid attacks by staying hydrated

Dehydration can increase uric acid levels, making it a risk factor for gout. Staying hydrated by drinking plenty of water helps your kidneys dilute and flush out uric acid, reducing the likelihood of flares. Unless you have a condition requiring fluid restriction, aim to drink half your body weight in ounces of water each day. Consistent hydration is key, so try to space out your water intake throughout the day rather than drinking large amounts all at once.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Zhu, Y., Pandya, B. J., & Choi, H. K. (2011). Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007-2008. Arthritis & Rheumatism, 63(10), 3136–3141. doi:10.1002/art.30520

2. Choi, H. K., Atkinson, K., Karlson, E. W., & Curhan, G. (2005). Obesity, Weight Change, Hypertension, Diuretic Use, and Risk of Gout in Men. Archives of Internal Medicine, 165(7), 742. doi:10.1001/archinte.165.7.742

3. Kakutani-Hatayama, M., Kadoya, M., Okazaki, H., Kurajoh, M., Shoji, T., Koyama, H., Tsutsumi, Z., Moriwaki, Y., Namba, M., & Yamamoto, T. (2015). Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. American Journal of Lifestyle Medicine, 11(4), 321–329. doi:10.1177/1559827615601973