Knee

What It Is

Gout is a type of arthritis. It causes sudden, severe pain in a joint, with hot, swollen, red skin over the joint. It usually affects the big toe, but it can also affect other joints in the feet, ankles, hands, wrists, elbows or knees (NHS, 2023). An attack usually lasts 1 to 2 weeks if it is not treated (NHS, 2023). Attacks can happen over and over, and leaving gout untreated may cause lasting damage to the joints (NHS, 2023). Gout is more common in men, especially as they get older (NHS, 2023).

Gout is caused by having too much uric acid in the blood, which can lead to crystals forming around the joints and causing pain (NHS, 2023). Not everyone who has high levels of uric acid in their blood ends up with gout.

The chances of getting gout are higher if you are overweight, drink alcohol, or take certain medicines, such as diuretics (water tablets) or some medicines for high blood pressure. It sometimes runs in families, and it is also more likely if you have high cholesterol, high blood pressure, kidney problems or diabetes (NHS, 2023).

Gout and Pseudogout Anatomy

Gout and pseudogout are two forms of crystal arthritis (crystal arthropathies), in which crystals form in the joints and make them sore. The crystals irritate the joint and the tissues around it, and the body reacts by making the joint red, hot and swollen. In gout, the crystals are made of monosodium urate (a salt of uric acid), while in pseudogout they are made of calcium pyrophosphate (NHS, 2023; Harvard Health Publishing, 2024).

In gout, the joint most often affected is the big toe (NHS, 2023). Pseudogout most often affects the knee or wrist, but it can also affect the shoulder, ankle or elbow, and it is most common in older people (Harvard Health Publishing, 2024). Attacks of both conditions often recur.

A joint which is suffering from gout can be red, hot, shiny and swollen.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Gout and Pseudogout

See your family doctor or nurse practitioner if you have symptoms of gout for the first time, or if you have gout and your usual treatment is not helping (NHS, 2023). Get treatment straight away if you feel an attack starting (NHS, 2023). Medical treatment comes first, and I can support it with gentle care for your joints and muscles, especially between attacks. See the My Approach tab for how I work.

1. During an Attack

The NHS (2023) suggests these things to help relieve the pain of a gout attack

Take any medicine you have been prescribed as soon as possible; it should start to work within 2 days.
Rest and raise the limb.
Keep the joint cool: apply an ice pack, or a bag of frozen peas, wrapped in a towel for up to 20 minutes at a time.
Drink lots of water (unless a family doctor or nurse practitioner tells you not to).
Try to keep bedclothes off the affected joint at night, and do not put pressure on the joint.

2. Anti-Inflammatory Medication

The NHS (2023) says that gout attacks are usually treated with a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, and Harvard Health Publishing (2024) says that treatment for pseudogout usually includes NSAIDs. (This medicine information comes from the NHS and Harvard Health Publishing, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

3. Diet and Lifestyle

There is not enough evidence to show that any specific diet prevents gout attacks or lowers uric acid levels, so the advice is to follow a healthy, balanced diet (NICE, 2022). Excess body weight and drinking too much alcohol may make gout attacks and symptoms worse (NICE, 2022). To help prevent gout coming back, the NHS (2023) advises:

Lose weight if you are overweight, but avoid crash diets.
Have some alcohol-free days each week, and try not to drink more than 14 units of alcohol a week.
Drink plenty of fluids to avoid getting dehydrated.
Do not have lots of sugary drinks and snacks.
Exercise regularly, but avoid intense exercise or putting lots of pressure on your joints.
Try to quit smoking.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroids: steroid medicine given as tablets or an injection, which may be used for gout if the pain and swelling do not improve (NHS, 2023), or injected to reduce swelling in pseudogout (Harvard Health Publishing, 2024).
Colchicine: a prescription medicine that is one of the first-choice treatments for a gout attack (NICE, 2022) and may also be used to help prevent pseudogout attacks (Harvard Health Publishing, 2024).
Uric acid-lowering medicine: a long-term medicine, such as allopurinol or febuxostat, that lowers the level of uric acid in the blood, for people who have frequent gout attacks or high uric acid levels (NHS, 2023; NICE, 2022).
Joint aspiration: a procedure in which fluid is drawn out of a swollen joint with a needle, which can ease the pressure in pseudogout and can be tested to confirm the diagnosis (Harvard Health Publishing, 2024).

How I can help (see the My Approach tab)

Gentle care for the rest of your body during an attack
Hands-on work and gentle movement for stiff joints between attacks
Low-impact exercise and pacing advice

Tips

Paying attention to your weight, alcohol intake and overall diet can help reduce gout attacks (NHS, 2023).
Eat a healthy, balanced diet in moderate amounts to help control your weight and get all of the nutrients your body needs (NICE, 2022).
Keep your alcohol intake within the recommended limits and have some alcohol-free days each week (NHS, 2023).
Make sure you drink enough water and other fluids to stay hydrated (NHS, 2023).
Things that can trigger a gout attack include drinking too much alcohol, eating a very large meal, getting dehydrated, an illness that causes a high temperature, and injuring a joint (NHS, 2023).
Repeated attacks of gout over a long period, if not treated, can damage your joints and cause hard lumps called tophi under the skin (NHS, 2023).

Treatment

My Approach

Gout and pseudogout are treated medically: your family doctor, nurse practitioner or specialist decides on medicine to settle and prevent attacks. I work alongside that plan. If it's your first attack, or a hot, swollen joint comes with a fever or feeling unwell, please get it checked first (see When to get urgent help). I don't massage if you have a fever.

During an Attack

I leave the hot, swollen joint alone, apart from cool applications if they're comfortable
Shorter, gentler sessions on areas that aren't affected, such as the neck, shoulders and back
Gentle movement of nearby joints, only as far as is comfortable
Advice on resting and raising the joint, and how to use ice safely at home

Between Attacks

Warm applications and hands-on work for muscles and joints that have stiffened after attacks
Gentle joint mobilisation for stiffness, within a comfortable range
Strength and low-impact exercise such as walking, cycling or swimming, built up gradually without putting lots of pressure on your joints
Pacing your day and protecting sore joints

I keep off any hard lumps (tophi) under the skin and any broken or fragile skin. If pain lasts more than about an hour after treatment or exercise, we've done too much and we scale back.

What to Expect

Typical Course

Typical course: During an attack, visits are optional and short. Between attacks, most people come about weekly at first, then every few weeks, with a reassessment at about 4 to 6 weeks. Untreated, an attack usually lasts 1 to 2 weeks, and prescribed medicine should start to work within 2 days; preventing future attacks follows your medical team's plan.

What I Focus On

Working With Your Medical Team

Flare-Aware Care

Gentle Joint Mobility

Low-Impact Exercise

Pacing & Joint Protection

Please read

When to See a Doctor First

When to get urgent help

If you have sudden pain and swelling in a joint and the pain is getting worse, or you also have a very high temperature (or feel hot, cold or shivery), or you feel sick or cannot eat, you could have an infection inside the joint (NHS, 2023). Call 911 or go to the emergency room at your nearest hospital.

Sources

References

Harvard Health Publishing (2024) Pseudogout (CPPD). Available at: https://www.health.harvard.edu/a_to_z/pseudogout-cppd-a-to-z (Accessed: 7 October 2026).
National Institute for Health and Care Excellence (2022) Gout: diagnosis and management (NG219) – Recommendations. Available at: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations (Accessed: 7 October 2026).
NHS (2023) Gout. Available at: https://www.nhs.uk/conditions/gout/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooGout and Pseudogout

What It Is

Gout and Pseudogout Anatomy

Self-Care & Treatment

How to Treat Gout and Pseudogout

1. During an Attack

2. Anti-Inflammatory Medication

3. Diet and Lifestyle

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

During an Attack

Between Attacks

Typical Course

When to See a Doctor First

When to get urgent help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooGout and Pseudogout

What It Is

Gout and Pseudogout Anatomy

Self-Care & Treatment

How to Treat Gout and Pseudogout

1. During an Attack

2. Anti-Inflammatory Medication

3. Diet and Lifestyle

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

During an Attack

Between Attacks

Typical Course

When to See a Doctor First

When to get urgent help

References

Related Conditions

Anterior Cruciate Ligament Rupture and Reconstruction

Baker's Cyst

Blount's Disease

Bowed Legs

Book a session