Rheumatoid arthritis (RA) and gout can be confused with each another when gout causes nodules to form in the hands or feet as they can in RA.
People can have both RA and gout, although the causes and treatments of each are different. An estimated 2 percent of people with RA will also experience gout.
Doctors can treat both conditions, but it is important that people receive the correct diagnosis to determine the most appropriate treatment.
RA vs. gout
Rheumatoid arthritis commonly affects the hands and knees.
RA is an autoimmune inflammatory condition.
It occurs when the body’s immune system mistakenly attacks healthy cells in the synovial tissues or linings of the joints.
This reaction causes inflammation, pain, and swelling. It usually occurs in the hands, wrists, ankles, and knees on both sides of the body.
Over time, repeated bouts of swelling can lead to joint damage.
Gout is also an inflammatory disorder, but it is not an autoimmune condition. Instead, a person with gout develops high levels of uric acid in their blood.
Uric acid is present in foods and drinks, and taking certain medications can also increase the amount of uric acid in the body.
These uric acid crystals can deposit in the synovial tissues, especially in the hands, feet, and elbows.
Who do RA and gout affect?
RA affects more women than men. An estimated 1.5 million people in the United States have RA, and the condition affects almost three times as many women as men.
On the other hand, gout affects more men than women. An estimated 4 percent of American adults, or about 6 million men and 2 million women, have gout.
Symptoms and long-term effects
Some symptoms of RA and gout are different, including the areas affected and the long-term effects.
Doctors do not associate gout with causing the range of long-term problems that RA can, such as heart and respiratory diseases.
Symptoms of RA
A person with RA will experience bouts when their symptoms are worse and periods where symptoms reduce or disappear. Doctors call these flares and remissions.
During the early flares of RA, symptoms may include:
- fatigue
- fever
- pain, aching, or stiffness in the joints
- stiffness in more than one joint
- pain and stiffness on both sides of the body, such as both wrists or ankles
- weakness
- weight loss
RA can lead to progressive and long-term complications, even with medicines. Long-term effects of RA include:
- bone density loss
- damage to the joints
- changes in the appearance and mobility of hands and feet
- premature heart disease
- scarring and inflammation in the eyes
Symptoms of gout
Similarly to an RA flare, people may get periodic attacks of gout that come and go. People experience an attack of gout or acute gout when excess uric acid crystals deposit in the joints.
Gout often occurs after a trigger, such as drinking too much alcohol, which increases the quantity of uric acid crystals in the body.
Symptoms of gout in the joints may include:
- reduced range of motion
- swelling
- tenderness
- warmth
The joint most commonly affected by gout is the big toe. Gout does not usually affect multiple joints in the earlier stages, during an acute flare-up.
People can also experience gout in their ankles, fingers, elbows, or wrists.
Gout does not usually cause the same autoimmune reactions as RA, such as fever and brain fog.
Causes and risk factors
Drinking alcohol regularly can increase the risk of developing gout.
RA is caused by problems with a person’s immune system, though doctors do not know why this occurs in some people and not others.
Individuals with the following risk factors are more likely to experience RA than others:
- Age: According to the Centers for Disease Control and Prevention, the onset of RA typically occurs in adults in their 60s.
- Sex: Women experience RA more often than men.
- Genetics: A family history of RA makes people more likely to experience the condition.
- Body mass: People with obesity are more likely to experience RA.
- Smoking: Those who smoke or experienced exposure to cigarette smoke in the womb are more likely to have RA.
Gout occurs when a person’s body builds up excess amounts of uric acid. Some people naturally produce excess uric acid, which can make gout more likely.
People with the following risk factors are more likely to experience uric acid build-up, or gout, such as:
- Age and sex: Men are more likely to have gout when they are under age 60. After that time, women may experience gout as much as men.
- Genetics: People with a family history of gout are more likely to experience the condition.
- Health conditions: A history of certain health conditions, such as high cholesterol, high blood pressure, diabetes, and heart disease, make gout more likely.
- Medications: Taking medications, such as diuretics or “water pills” or medicines used to treat RA or psoriasis, can increase the risk of gout.
- Diet: A diet high in red meat, shellfish, alcohol, and sodas can all increase the likelihood a person will have gout.
- Body mass: People who are overweight are at a higher risk of developing gout.
In severe cases, people can experience chronic gout. This involves frequent gout attacks and joint damage. With treatment, a person can often manage their gout symptoms before the chronic effects occur.
Diagnosis
To diagnose RA or gout, a doctor will start by taking a person’s medical history and symptoms. They will ask about their diet, any medications they take, and any other chronic conditions.
A doctor will also conduct a physical exam and consider where a person is experiencing their symptoms. For example, if a person has gout, they will likely have pain in their big toe.
A doctor will also organize blood testing. If a person has gout, their uric acid levels will usually be high. A doctor may order other blood tests to check for properties that are also frequently high in people with RA, including:
- anti-cyclic citrullinated peptide
- C-reactive protein
- erythrocyte sedimentation rate
- rheumatoid factor
Doctors may order imaging tests, such as X-ray and MRI scans, to check for possible damage to soft tissue or bone.
Imaging tests can detect a buildup of uric acid crystals around the joints or if there are signs of inflammation around the joints that could resemble RA.
A doctor may use a needle to remove fluid from the swollen joint to test for the presence of uric acid crystals that may indicate gout.
Treatments
Prescription medications are the usual treatments for RA and gout.
Correctly identifying RA versus gout is important because the treatments are different.
Treatments for gout include:
- Taking medications to reduce the amount of uric acid in the body, such as colchicine, which may work for an acute attack or general prevention.
- Taking medications, such as allopurinol, to block the production of uric acid, or to encourage the removal of uric acid, such as probenecid. These medicines can help to prevent attacks.
- Taking medications to reduce acute gout inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
- Embarking on dietary changes, such as avoiding foods and drinks known to cause gout.
People may be able to slow or halt the progression of RA by taking medications that reduce inflammation in the body and slow the immune response that contributes to the inflammation.
RA treatments include:
- disease-modifying antirheumatic drugs (DMARDs)
- biologic response modifiers (biologicals)
- eating an anti-inflammatory diet
A person may need to try several different medications before finding the ones that best manage their condition.
Lifestyle changes, such as losing weight and stopping smoking, may also help to slow the progression of RA.
Outlook
RA and gout are both forms of arthritis or arthritides, but they cause different symptoms and have different long-term effects and treatments.
Gout is usually related to lifestyle, such as diet, and inflammation frequently occurs in the big toe. In contrast, RA usually causes pain in the hands, wrists, and ankles.
Each condition causes changes in the blood that a doctor can detect. Accurate diagnosis and treatment are vital because each condition has different underlying causes and treatments.
