Correlation between Gout and PVNS

[Dave]

Back in May of 2015 I woke up with an extreme pain in my left knee and minimal range of motion. Thinking I must had injured my knee although I could not determine how, I went to a Orthopedic center and presented my symptoms. The doctor was stumped and gave me a cortisone shot and a knee brace. Just as he was leaving he asked if I had gout, which at that time I did not believe I did.

About a couple months later the foot pain and swelling started in the AM and my regular doctor confirmed with a blood test that I did indeed have gout. I tired to manage it for several years until January of last year I had an attack that was so severe in my foot I wanted to cut it off.

I was immediately prescribed Allopurinol and Prednisone. Additionally I purchased a UA meter and began a diet change. Since January of 2018 I’ve been attack free and maintaining an average of UA of 4.2 mg/dL since then.

About a month ago I was traveling when suddenly my left knee gave out. It was painful at first then subsided almost right away and I was walking just fine for a day or two. I had several other other episodes which prompted me to visit my ortho doctor. An initial x-ray was normal and I was sent home to see if this would subside. It didn’t and they ordered up a MRI to rule out a torn meniscus.

I received the results and was relieved to find out my meniscus was fine but PA told me it appeared I had a small mass (1.8 cm) in the knee. Placement was in the joint of the femur. He referred to it as pigmented villonodular synovitis (PVNS) which has not been 100% confirmed. Upon research I found this is very rare especially in older adults (I’m 59) and treatment varies from cortisone to arthroscopic surgery to remove the mass which are benign. Also from research these can return and bone damage may occur which then would lead to a knee replacement.

Today I was wondering if there was a correlation between gout and PVNS. Surprisingly I did find one study that suggested gout could mimic PVNS in gout sufferers. Could this be tophi that became dislodged which caused the “locked knee” and pain? Has anyone else heard of this or experienced it themselves?

I’m suspicious now.

David

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PVNS of the Knee or Gouty Tophi?

[Keith Taylor]

Welcome back, Dave

First, a question. Because I notice on both your posts that you describe uric acid test results from a home meter. So I’m wondering if you’ve had any blood tests run by your doctor?

If so, it would be useful to compare lab test results with your home uric acid meter. Because I’ve seen significant differences in the past. But also some good correlations. Especially when gout sufferers have adopted a meticulous unvarying test routine.

As for PVNS, I’ve seen many cases where suspected synovitis has eventually been diagnosed as gouty tophi. Also, I’m reviewing cases to see if there are examples of the opposite situation. However, the general view is that gout symptoms often mimic other rheumatic diseases. So it’s important to consult an experienced rheumatologist. Because such gout specialists can test joint tissue to get a better diagnosis. Then that leads to the best treatment.

[Dave]

Keith,

The last two blood tests I had within the last year, both values for UA were within .5 mg/dL of my home meter. I feel confident that my meter is providing accurate levels. All my readings are logged in Excel so I can see at a glance what the average is and the trending. I have cut back my Allo by 50% (150 mg) which resulted in a small increase in the trend line but is now holding steady at 4.2. Liver function tests also are within normal ranges. My goal is to get my Allo down to 75 mg and UA no greater then 5.5 mg/dL.

AS for the PVNS, I do have an appointment this Thursday with my Ortho MD to get his thoughts and best if any treatment plan. Since I also live very close to the Mayo Clinic in Rochester, MN, it’s highly likely I’ll get an appointment there since they specialize in rare conditions like PVNS. I’l be sure to mention a consult with a rheumatologist. I’m highly suspicious that this is gout and not PVNS although with my UA being in check for over a year, who knows.

[Author]

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