What Causes Periodic Painful Swelling And Stiffness In Knee And Ankles?

Posted on Fri, 14 Nov 2014

Question: i get periodic painful swelling and stiffness in a knee ankle or foot. it can affect either leg and usually only affects one area at a time. it could be the left knee then the right foot. it may involves redness and be hot or not. drinking lots of water and taling ibuprophin seems to help bring it down. It can last for two to ten days. ussually shorter. I think it may be an allergic reaction to certain foods such as red meat and grains. i do not eat processed food or refined sugars of any kind. i do not have gout. played lots of sports when younger and had some injuiries. no broken bone. torn cartiledge in both knees but ok now according to orhopod. saw a rheamatologist but not diagnosed with RA or anything. what could in be. thinking of going to a naturopath and checking for food allergies.

Answered by Dr. Naval Mendiratta (1 hour later)

Brief Answer:
? gout

Detailed Answer:
Good evening sir

Thank you for writing on health care magic

I have gone through your history. Episodic swelling in a single joint, which gets resolved with painkillers and anti inflammatory leaves us out to very few diagnosis.

Considering your age and the nature of arthritis you are describing it does go in favour of gout. The diagnosis of gout can be made by removing the fluid from the joint and sending it for examination. Uric acid levels may be normal during the attacks because of inflammation.

The other possibility could be reactive arthritis that is single joint arthritis which happens after an infection elsewhere in the body.

It is very less likely to be due to allergy to foods you are taking as the allergic reactions don't manifest as arthritis.

Do let me know a few queris:

1. Your uric acid levels

2. Have your joint been aspirated yet for fluid examination?

3. Do you have any bowel symptoms like loose stools or any skin complaints?

Kindly let me know these queries. Would be happy yo guide you further

Take care.
Regards

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Naval Mendiratta (4 hours later)

I had my uric acid levels checked and while higher were in the acceptable range. While I am positive I have had gout attacks in the past, it was never diagnosed. Sent to orthopedic and rheumatologist but they did not it was gout. Had a cortisone shot in one knee which was quite effective. The joint has never been aspirated. Cast iron stomach and no skin issues other than in one ankle instance the a Layer of shin came off. I notice that it can get me when I am run down or sick ( as I am currently). Also athletic stress can bring it on).

PS. ALSO further to my last answer, in the current instance NY knee is not red or hot. The inner knee has a spot which hurts if pushed. I think it is the bursa. The last on my ankle it was red and sensitive to touch. Also, some skin was she'd once it was over. Might be gout and reactive? Can you have both?

Finally, the knee swelling is mainly across the top and very hard. Hope this helps.

Answered by Dr. Naval Mendiratta (54 minutes later)

Brief Answer:
? gout

Detailed Answer:
Good evening

Well, considering your history i still feel it is gout. The problem your rheumatologist are facing is the uric acid levels being in a normal range. But as I mentioned earlier, uric acid could be still normal while you have an attack as the inflammation in the joint increases the excretion of uric acid. Your response to cortisone injection was good as well, which again goes in favour of inflammation.

Gout and reactive normally dont normally co exist. It is a differential diagnosis for single episodic joint swelling.

What i suggest is:

1. you could get an MRI of your knee or Ultrasound to rule out the possibility of bursitis.
2. If it is normal, best is to wait for the next episode and get it aspirated and examined for crystals.
3. Also, get an X Ray of Pelvis done to look for Sacroilitis. Some forms of Spondyloarthopathy( Like reactive variant) can cause these symptoms as well. But yes, patients do experience back pain and neck pain in this condition.

Periodic swelling, in different joints, response to analgesics and cortisone , i would still go for gout. I guess we can approach step wise here and come to a conclusion.

Hope the information was useful

Do let me know your further queries. Would be happy to help you out here.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Naval Mendiratta (2 hours later)

Dr. Mendiratta: This was very helpful indeed! I did have ultrasounds and MRI's on both knees in the past three years [had at one time torn cartiledge on both]. The orthopaedic Dr. has since advised they are both knees are fine [a little worn consistent with my age]. I also modified my diet which seemed to help. My events all seem consistent with being worn down, not drinking enough water and too much rich food which is consistent with gout. My knee however while swollen is not red or sensitive to touch except for the one spot on the inside when pressed on. Could that still be gout?

I will follow your recommendations. Bursitis - I never get it on the heal or other toes so I think I will rule that out. I'll check the sacoilitis although my back and neck are strong. Spondyloathopathy - I very rarely ever have back pain of any kind and not in the pelvis. Many thanks, XXXXXXX

Finally, could it be Pseudogout?

Answered by Dr. Naval Mendiratta (26 minutes later)

Brief Answer:
synovial fluid examination can confirm the same

Detailed Answer:
Good evening XXXXXXX

It s good to see you have a good amount of knowledge about the diseases.

Dehydration and high protein diet are both risk factors for gout as rightly said.

About pseudogout,,it normally occurs in a joint with osteoarthritis. It can be seen diagnosed with an x ray as well as their is a white line seen on the bones. But the definite diagnosis remains with synovial fluid examination.

For gout and pseudogout, you need to take colchicine for a while to help control the inflammation and the attacks do get controlled. The difference comes when to start urate lowering therapy.

I will suggest to control the diet and keep adequate hydration. If you get another attack get the examination done and consult your rheumatologist regarding starting colchicine.

I hope I have been able to sort your queries. Do let me know for more queries. I will be happy to discuss it out with you

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Shanthi.E