If you have rheumatoid arthritis (RA) and find that your symptoms aren’t improving, you may also want to ask your doctor about gout. Researchers used to believe that you couldn’t have both conditions at the same because people with RA often were taking high doses of aspirin. High-dose aspirin treatments can expel uric acid via the kidneys, lowering the risk of gout. In 2012, 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. Another study reviewed cases of RA and found that 5.3 percent of people with RA had or developed gout.
The confusion may lie in the symptoms. Symptoms of gout may appear similar to those of RA, particularly in the later stages. But both the causes of these two diseases — and their treatments — are very different. Read on to learn more about RA and gout.
RA and uric acid
Both RA and gout are inflammatory diseases that cause pain and swelling in your joints. 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.
Untreated gout can show symptoms that are very similar to RA, especially if it’s in the later stages.
But the causes of RA and gout are very different, and as a result, so are the treatments. Your doctor will recommend treatment options based on your diagnosis.
Causes of gout
Unlike RA, gout is better understood and treatment is straightforward, once diagnosed. The symptoms for both conditions may seem similar, but gout and RA 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, like diuretics or aspirin
- having kidney disease
- being born with certain genetic predispositions
One of the reasons gout may appear to be 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 small blood vessels leads to bumps or nodules under your skin. In gout, sodium urate may build up under your skin. When this happens, the resulting lumps can look a lot like RA nodules.
To diagnose gout, your doctor will order different tests. These tests may include:
- joint fluid test to look for urate crystals
- ultrasound to look for urate crystals
- blood test to look for levels of uric acid and creatinine in your blood
- X-ray imaging to look for erosions
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.
Treatment for gout may include medications and lifestyle changes.
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 gout flare-up. Treatment may include:
Colchicine: The drug colchicine (Colcrys) inhibits inflammation and reduces gout pain. But it has some side effects such as nausea and diarrhea.
Corticosteroids: These can be in pill form or injections to control inflammation and pain. Due to the side effects, this is usually for people who can’t take NSAIDs or colchicine.
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, nausea, and kidney stones.
Some lifestyle changes are effective for gout relief. These include:
- avoiding alcoholic beverages
- staying hydrated
- limiting foods that are high in purines, like red meat, organ meats, and seafood
- exercising regularly to maintain a healthy weight
Some foods may have potential to lower uric acids. According to the Mayo Clinic, coffee, vitamin C, and cherries may help with uric acid levels. But they won’t treat your gout attacks.
Always talk to your doctor before starting an alternative approach, as it may interact with your medications. Complementary and alternative medicine isn’t meant to replace any of the medications your doctor recommends.
Researchers used to believe that you couldn’t have gout and RA at the same time because RA treatments helped remove uric acid. But current treatments don’t rely on high aspirin doses. And recent research shows that it’s possible to have gout, even if you have RA. People with RA are more likely to have higher levels of uric acid, which is associated with gout. They are also more likely to take low-dose aspirin for heart protection, which inhibits removal of the crystals from their body.
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.