Elbow and Knee Bursitis caused by Gout

Overview

• Gout is a well-recognized cause of bursitis.

• Gouty bursitis most commonly involves the olecranon bursa at the elbow and the prepatellar bursa at the knee.

Pathophysiology

• In gouty bursitis, uric acid crystals are frequently present within the bursal fluid.

• These crystals are needle-shaped and demonstrate negative birefringence under polarized light microscopy.

• The presence of uric acid crystals within the bursa does not exclude concurrent infection.

Laboratory Findings

• The white cell count in bursal fluid is usually lower than expected when compared with septic arthritis of a joint.

• Despite lower cell counts, infection may still coexist and must be actively excluded.

Aspiration of the Bursa

• Aspiration is essential for diagnostic evaluation.

• Aspirated fluid should be sent for:

  • Culture and sensitivity

  • Cell count

  • Crystal analysis

Clinical Considerations

• Gouty arthritis and bursitis may be bilateral.

• These conditions can be difficult to treat, particularly in chronic or recurrent cases.

• There is a recognized association between gouty bursitis and secondary infection, necessitating careful clinical and laboratory assessment.