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

? 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


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.
? 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.


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?
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

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