knee limp 3 months

[jonpayson]

As an individual who just recently accepted the fact that he has gout, I truly appreciate any insight on this topic, especially if its normal symptom of gout, and if it goes away in time.  Heres my backround:

Background: about 4 months ago i started getting gout symptoms in feet, knees, ankles, never had high UA (only 6.2), but Dr diagnosed based on symptoms.  One of the symptoms was a large amount of swelling in the left knee and calf about 3 months ago.  After a hospital test that swelling was diagnosed as a ruptured bakers cyst.  When the swelling went down a month later, i developed a limp, which has been present ever since (4 months now).  In addition, that knee (as well as the other) periodically would swell up for a few days.  The limp gets better and worse…but is always there.  MRI showed very minor chondralcia, and the surgeon offered exploritory surgery.

Started allipurinol about a month ago, up to 300 mg for 1 week.  Most other symptoms have gone away..or significantly diminished accept for the limp. 

My question:  is this a normal symptom (the limp), Do i need the surgery, what is the recovery time?  The pain is bearable without pain meds, but the limp keeps me from working….and emotionally im at my wits end

[limpy]

Hang in there if it's gout the Allop will clear it. Many on here will tell you of their success on it if you do a little digging. I've been on it for 3 month and it's working for me. Good luck LIMPY 

[vegetarianGuy]

jonpayson said:

Started allipurinol about a month ago, up to 300 mg for 1 week.  Most other symptoms have gone away..or significantly diminished accept for the limp. 

---

3 to 6 months on AlloP is the magic number for AlloP to fix things. Can take longer depending on individual case. If you really have Gout then hang in there and AlloP will make you good as new. That is assuming that you did not ignore Gout for years and no irreversible joint damage has already been done.

[jonpayson]

Thank you for your help, The Dr is convinced it is gout, and he ruled out RA, lupus, infection, with all of the blood tests.  I was originally skeptical, but after the research and the response to the allipurol I support his diagnosis.  Especially the comments about the joint “twinges” on this site.  I am still amazed at the fact that my joints (especially the knees) can just “randomly” swell without any trama within a few hours.  Im sure you all can relate, but literally within a few hours my knes will be so tight that i can barely bend them. 

2 more questions if you have time:

1) When i went from 100-200 allipo they swelled up within 2 days, and when i went from 200-300 allip they swelled up again within 2 days.  Im not a Dr, but it seems like the fact that the change in allip coencided with the swelling would support a gout diagnosis (ie sensitivity to uric acid changes)

2) The residual swelling in 3 of the joints that have been affected (both knees, and foot) have not return to 100%, they are more like 50-75% of what the joints were before the initial attack, and it has been about 3-4 months since the original attack, and i have been on meds for a month now (20 mg pred, colchocine .6, 300 allup).  Some of the other more minor affected joints (smaller foot joints, wrist,) have returned to their pre-attack level, with no apparent residual affects.  In your experience, is it common for the joint to be damaged and take a very long time to go back to “normal” based on damage caused by the swelling (ie trama caused by walking on the joint when its swollen), or is it just take a long time for the needle like uric acid deposites to stop irritating it.  The reason i ask, is if its an orthapedic issue, id like to get the surgery done now (and get back to work quicker) rather than wait the three months to see if it will get better on its own, and then get the surgery.

You all are very helpful,

Regards,

JP

[odo]

jonpayson said:

Thank you for your help, The Dr is convinced it is gout, and he ruled out RA, lupus, infection, with all of the blood tests. I was originally skeptical, but after the research and the response to the allipurol I support his diagnosis. Especially the comments about the joint “twinges” on this site. I am still amazed at the fact that my joints (especially the knees) can just “randomly” swell without any trama within a few hours. Im sure you all can relate, but literally within a few hours my knes will be so tight that i can barely bend them.

Amazing, yes, but quite typical of a gout flare

2 more questions if you have time:

1) When i went from 100-200 allipo they swelled up within 2 days, and when i went from 200-300 allip they swelled up again within 2 days. Im not a Dr, but it seems like the fact that the change in allip coencided with the swelling would support a gout diagnosis (ie sensitivity to uric acid changes)

Agreed

2) The residual swelling in 3 of the joints that have been affected (both knees, and foot) have not return to 100%, they are more like 50-75% of what the joints were before the initial attack, and it has been about 3-4 months since the original attack, and i have been on meds for a month now (20 mg pred, colchocine .6, 300 allup). Some of the other more minor affected joints (smaller foot joints, wrist,) have returned to their pre-attack level, with no apparent residual affects.

So, the meds are working…

In your experience, is it common for the joint to be damaged and take a very long time to go back to “normal” based on damage caused by the swelling (ie trama caused by walking on the joint when its swollen), or is it just take a long time for the needle like uric acid deposites to stop irritating it.

Both

The reason i ask, is if its an orthapedic issue, id like to get the surgery done now (and get back to work quicker) rather than wait the three months to see if it will get better on its own, and then get the surgery.

So, it seems you haven't really accepted you've got gout and are still hoping it might be something else (chondromalacia) – so much so that you're willing to let a surgeon who doesn't know what's wrong with you operate to see if he can find anything interesting… (trust your Dr)

Denial is a common symptom of early gout diagnosis. Gout never “goes away in time” (except by proper management through urate lowering therapy) and surgery should always be as a last resort for symptoms far more serious than those you describe.

Being a gouty is an exercise in patience. Pull up a chair, make yourself comfortable while the meds do their job and stop looking at your watch

[zip2play]

I don;t trust the diagnosis.

Firstly gout is not diagnosed by ruling out other arthritic diseases. Secondly, a UA of 6.2 does not support a gout diagnosis. Thirdly, with myriad incidents of doctors probing your knee swelling an easy thing would have been to take joint fluid and look for crystals of uric acid in the fluid.

I presume they left you with a diagnosis of chondromalacia? That's “jumper's knee” or patellar tendonitis. A couple guys at my gym get good results with a tight band placed right under the kneecap. Give it a try.

If you want more evidence about gout, you can try some relatively high dose colchine. If it doesn't help a lot, then you get even further from a gout diagnosis.

I do not think your doctors are the sharpest knives in the kitchen drawer and for this reason, I'd go very slowly into any prospects of surgery. Exploratory surgery went out with high button shoes…it;s for doctors who have never heard of an MRI/

(Early in the disease, when a gout attack subsides, relief is usually complete and fast.)

So for lots of reasons, I think your knee pain is NOT gout.

[trev]

One reading  of SUA given does not make or break gout diagnosis to me. It's well known levels vary- and lower during attacks.

It sounds like another case of joint symptoms [no pun intended ] where gout  in the equation just seems fllip medics imaginations into neutral. It does sound like the lower limb problems have resolved under ULMeds treatment, which is positive.

If your surgeon has seen inside your knee he must be able to advise on a follow up, surely?

As Zip says, an MRI is a lot easier, if far from cheap.

[jonpayson]

I appreciate the feedback, maybe a little more background can shed some light on why he diagnosed it based on symptoms….let me know what you think:

1) random foot swelling, which left unable to walk for 3 weeks, no trama, not able to bear any wait on it

2) a week later massive l knee swelling

3) another few days after the left knee…..R knee

4) then a series of smaller joints in the feet/toes/ankles/wrists over the next month or so.

5) since alli and pred and colch only the L and R knee remain affected, the rest of the pain all vanished. the constant limp in the L leg and slight swelling constant in the R knee are only lingering symptoms.  Sometimes all the swelling goes away, both swelling increased while going from 100-200-300 of ali.

6) no personal history of any injuries or arthritis

thanks for the help.

[trev]

I hope I'm not sounding like Pavlovs' dog , but knees [especially difficult to treat] always get me slavering aobout psuedo Gout, caused by excess Calcium, rather than uric acid.

This is as painful and rather more intractable than gout from all accounts. I've talked to people in the surgery about this and it's easily missed.There is treatmenr for it, but I can't remember how easy blood diagnosis is.

Maybe you could raise the prospect of Psuedogout with your Dr?

[zip2play]

jon,

Before that “Baker's Cyst” ruptured, were you aware of HAVING it? It is a rather prominent swelling at he back of the knee. A Baker's cyst is usually caused by mangled cartilege or osteoarthritis but CAN be caused by gout. Conjecturing that one has a ruptured Baker's Cyst without ever having diagnosed the cyst is bad medicine.

Have another UA run, maybe even another ANA….good he ruled out the horrors like lupus, RA, scleroderma, Sjoergen's, etc.

If you are still taking allopurinol, 300 mg., continue it if it is helping your foot problems. There is no medical law that says you cannot have gout AND osteoarthritc knees with blown cartileges, a couple blown spinal discs and torn rotator cuffs….I've got them all. Maybe the knee will eventually resolve. There's also no law that you cannot go to 400 mg. allopurinol. Perhaps getting your SUA below 5.0 might yield more information.

How about an MRI of the knee to see what the joint looks like. Beware though, if an orthopedic surgeon does it you WILL get surgery because that's all they do…like mindless automatons. Certainly have an aspiration to look for crystals with the next swelling episode.

(Have a check for Lyme Disease antibodies…there's more of it around than most people imagine.)

Do you limp because of the PAIN or because something feels “stuck” in the knee?

[jonpayson]

The “ruptured Bakers Cyst” was diagnosed when my i had an echo exam on the legs after I experienced a arge amount of swelling to the knee and calf with pain (very rapid swelling).  Prior to that swelling, the only other symptoms i had ever had on either knee was an additional rapid swelling of both knees (but more on the left than the right) about a week earlier.  I was never diagnosed with a bakers cyst prior, but the dr said the echo showed a ruptured bakers cyst.

The mri of the knee show a “possible” menisis tear, but not confirmed.

As far as the limp:  it varies in severity, but general there is some pain, but the actual limp feels like it comes from not having the normal ability to fully straighten the leg while walking.  Also, when i got a cortizone injection in the knee, my limp went away for about a week.

I had thought that it was possible that i never had a bakers cyst, and the swelling was from gout alone, but the echo confirmed that it was a rupured bakers cyst, and im not sure if that is a definitive diagnosis or not.  I wil say this, during the week or so after the alleged bakers cyst ruptured, I was still recovering from my right foot which got swelled up and i was on crutches for, and the left knee/leg was excrutiating painful for about a week.  

JP

[zip2play]

but the actual limp feels like it comes from not having the normal ability to fully straighten the leg while walking.

That sounds like a torn meniscus (cartilege.) WHat happpens is that the floating part of the cartilege slips into the joint and interferes with straightening. The cure is usually to cut off the offending piece of cartilege. Mine is very rarely IN the joint anymore but I used to be able to wiggle it artound just under the skin on the inside of my knee. THe injury was 40 years ago and I never did anything about it and now the “lockup” occurs only a couple times a year and lasts only a couple minutes before slipping back out.

Doctor back a million years ago (high school) callled it a “mouse on the knee.”  Just fingering around now and I don;t know if I can even find it anymore…perhaps it reattached or simply wore away to nothingness.

I'd have had it removed long ago but for the fact that a dear college friend of mine had it done…and he died a day later, at age 29.

[jonpayson]

thanks for all the help….I really should not have that much complaining to do, it seems like the allup is working, its just the lingering swelling between the “attacks” that have me worried.  I guess that part is hard to grasp, i just do not understand why the joints stay swollen (although at a much lower level) after the pain goes away…the same thing happened to my foot, it stayed swollen and uncomfortable for a few months (and still is), I've only been on the higher level of allip for 2 weeks or so, but i really wold like to know that i will be able to go for a jog at some point in the future.  For never having pain to the foot or knees before, then to have the worst pain ever in the foot, and the constant swelling in the knees for the last 3 months..with no trama to link it to, just really confused me.  I guess i should feel lucky that im treating it now, but to be honest, i could not have ignored it if i wanted to, it has just been too painful.

….and yes, i probably still havnt fully accepted the fact that i am probably having the correct treatment for my issues,

JP

[limpy]

I'VE BEEN ON ALLOP FOR 3 MONTHS AND IT'S JUSTING STARTING TO REALLY GET RID OF THE PAIN. I HAD MY WORST ATTACK A WEEK AFTER STARTING IT. THEY HAVE GOTTEN LIGHTER AND LESS OFTEN SINCE THEN.

[jonpayson]

Ok, so im approaching the 2 month mark on 300 allip.  My limp is VERY deminished.  Still a little pain in my left knee, and weakness, but the obvious limp has not been around for over 2 weeks.  Sometimes ill get a little reminder, but it has not lasted more then an afternoon or so.

One thing that has not gone away is the swelling in the Right knee.  Not a lot of pain, and never a limp.  Just a small amount of swelling that is there 90% of the time.  squishy when touched (as opposed to tight and hard like it was before the allip).  

Anyone else have sustained swelling in a joint without much pain that just seems to linger on??

JP

[trev]

Jon- I should explain myself better..I mean that events are less severe -rather than extended [as that is actually the case, often with treatment]. On my uriscoric I get quite bad twinges at night recently after many miles walking hard @ w/e's. They do not  threaten to develop into a flare/attack though.

I've had  a  badlyswollen knee with pain this year- but it wasn't really gout. I suspect my immune system is a bit hyper, and *BP meds also affect fluid retention too. Antibiotic helped here. [Reactive arthritis?]

*You haven't mentioned these- do you use them?

[zip2play]

Jon,

Although I have no clue as to the mechanism there is the VERY often seen correllation between edema and very hot weather?

It probably has something to do wth the body conserving sodium, but don't quote me,

[Author]

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