Overview
Both rheumatoid arthritis (RA) and gout are inflammatory diseases that cause pain and swelling in your joints.
Symptoms of gout may appear similar to those of RA, particularly in the later stages of gout. However, these two diseases — and their causes and treatments — are distinct.
If you’re being treated for RA and find that your symptoms aren’t improving, you may also want to ask your doctor about gout. It’s possible for a person to have developed both conditions at the same time.
Gout is caused by elevated levels of uric acid in the body, although such levels do not always lead to gout.
High-dose aspirin treatments can expel uric acid via the kidneys, lowering your risk for gout. Because high doses of aspirin were once a common RA treatment, researchers used to believe that you couldn’t have both gout and RA at the same.
Low-dose aspiring treatments can be a risk factor for gout.
In 2012, however, the Mayo Clinic found evidence that says otherwise.
Other research also shows that the occurrence of gout in people with RA is more common than previously suggested. A 2013
One study of women with self-reporting RA showed they had significantly higher levels of serum uric acid. An excess of this bodily waste product in your blood can trigger gout.
It does this by building up and forming urate crystals. These crystals may then accumulate in your joints and cause pain and inflammation.
RA occurs when your immune system responds abnormally by attacking your joints, and sometimes your organs, instead of foreign invaders like viruses that enter your body.
It’s a different cause of inflammation, but the symptoms can appear similar. This may make diagnosis more difficult.
One of the reasons gout may be confused for RA is that both conditions can cause nodules to form. These lumps develop around the joints or at points of pressure such as your elbows and heels. The cause of these bumps depends on which condition you have.
In RA, inflammation around joints may lead to bumps or nodules under your skin. These masses are not painful or tender. In gout, sodium urate may build up under your skin. When this happens, the resulting lumps can look a lot like RA nodules.
| Symptoms of rheumatoid arthritis (RA) | Symptoms of both conditions | Symptoms of gout |
| pain that may be acute from the start or appear slowly over time | lumps under the skin | starts with immense pain and inflammation in the big toe |
| pain and stiffness in several of your joints | pain and swelling in the joints | pain that appears after sickness or injury |
| more likely to affect the fingers, knuckles, wrists, and toes | affects other joints over time |
The symptoms for both conditions may seem similar, but RA and gout have different causes. RA is an immune system issue, while too much uric acid in your bloodstream causes gout.
Excess uric acid can be the result of several factors, including:
- drinking too much alcohol
- eating foods that contain a substance called purines, which get broken down to become uric acid
- taking certain medicines, such as diuretics or aspirin (Bayer)
- having kidney disease
- being born with certain genetic predispositions
To diagnose gout, your doctor will order different tests. These tests may include:
- a joint fluid test to look for urate crystals
- an ultrasound to look for urate crystals
- a blood test to look for the levels of uric acid and creatinine in your blood
- X-ray imaging to look for erosions
- a dual energy CT to look for uric acid deposits in tissues
Now that healthcare professionals also know it’s possible to have both RA and gout, they can prescribe the specific treatments you need for each disease.
Talk to your doctor if you’re in doubt about your condition. They’ll be able to help you get on the path to managing your condition.
Gout is better understood than RA and treatment is straightforward, once diagnosed. Treatment for gout may include medications and lifestyle changes.
Medication
Your doctor will prescribe medications to treat gout, depending on your overall health and preferences. The main goal is to treat and prevent the severe pain that comes with a flare-up. Treatment may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These can be over-the-counter medications such as ibuprofen (Advil) or prescription NSAIDs such as indomethacin (Tivorbex) or celecoxib (Celebrex).
- Colchicine. The drug colchicine (Colcrys) inhibits inflammation and reduces gout pain. However, it has some side effects such as nausea and diarrhea.
- Corticosteroids. These are available in pill form or via injections, and they’re used to control inflammation and pain. Due to the side effects, corticosteroids are usually reserved for people who can’t take NSAIDs or colchicine.
- Xanthine oxidase inhibitors. These are prescription drugs such as allopurinol (Allopurinol) or febuxostat (Febuxostat). They reduce uric acid production by inhibiting the activity of xanthine oxidase and are primarily used to treat gout associated with hyperuricemia.
If your gout attacks are frequent, your doctor may prescribe medications to block uric acid production or improve removal. These medications may also cause side effects such as:
- a severe rash (Stevens-Johnson syndrome and toxic epidermal necrolysis)
- nausea
- kidney stones
- bone marrow suppression (aplastic anemia).
Lifestyle changes
Some lifestyle changes are effective for gout relief. These include:
- avoiding alcoholic beverages
- staying hydrated
- limiting foods that are high in purines, such as red meat, organ meats, and seafood
- exercising regularly to maintain a healthy weight
Some foods may have potential to lower uric acids. Coffee, vitamin C, and cherries may help with uric acid levels.
However, complementary and alternative medicine isn’t meant to replace any of the medications your doctor recommends. Always talk to your doctor before starting an alternative approach, as it may interact with your medications.
Researchers used to believe that you couldn’t have gout and RA at the same time because RA treatments such as aspirin helped remove uric acid.
However, current RA treatments don’t rely on high aspirin doses. Recent studies also confirm that it’s possible to have gout even if you have RA.
Gout is highly treatable, but the treatments are different from those for RA.
Talk to your doctor if your treatment for RA doesn’t seem to be working, especially if your discomfort started in your big toe. Your doctor will work with you to find a treatment that brings you relief.