Rheumatoid arthritis vs. gout: Symptoms and causes

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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 develops gout because of high levels of uric acid in their blood.

Uric acid is present in foods and drinks. Taking certain medications can also increase the amount of uric acid in the body. Uric acid crystals can deposit in the synovial tissues, especially in the hands, feet, and elbows.

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. According to a 2014 article, it affects over 3% of adults in the U.S., and that number is rising. It is more common among males aged 40 or over and females after menopause.

What are 10 risk factors for RA?

RA and gout both involve swelling and inflammation, but some symptoms are different. This includes the areas affected and the long-term effects.

Unlike RA, gout does not cause inflammation throughout the body and does not cause damage to tissues in other organs, such as the heart and lungs. However, both RA and gout can involve the kidneys, according to the Arthritis Foundation.

Symptoms of RA

A person with RA will have times when their symptoms worsen and others when they 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 multiple joints
• pain and stiffness in joints 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:

• early heart disease
• high blood pressure, high cholesterol, and diabetes for those with RA and obesity
• damage to joint tissue
• loss of balance
• changes in the appearance and mobility of hands and feet
• problems with the heart, lungs, eyes, and other organs

People with RA may experience employment difficulties, especially those who do physical work.

How does RA affect different parts of the body?

Symptoms of gout

The symptoms of gout can also come and go. An attack can occur when excess uric acid crystals deposit in the joints. A trigger may increase uric acid levels in the body. Those triggers may include ingestion of alcoholic beverages and foods rich in purine, such as some seafoods, meats, and organ meats.

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, but it can also affect other joints as it progresses. RA is more likely to involve multiple joints at one time and can cause fatigue, low-grade fever, and weight loss.

What types of arthritis can affect the knee?

RA results from a problem with the 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:

• Age: According to the Centers for Disease Control and Prevention, RA usually appears when a person is in their 60s, though it can happen at any age.
• Sex: It is two to three times more common in females than males.
• Genetics: Having specific genetic features can make it more likely to develop.
• Body mass: People with obesity are more likely to have RA.
• Smoking: Smoking or exposure to cigarette smoke or nicotine-containing products before birth can increase risk
• Socio-economic factors: Children from families with a low income have a higher risk in adulthood.
• History of giving birth: Those who have never given birth may have a higher risk.

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 and gout:

• Sex: It is more common in males.
• Health conditions: A history of high blood pressure, diabetes, heart disease, kidney problems, and other aspects of metabolic syndrome make gout more likely.
• Medications: Taking medications such as diuretics or “water pills” can increase the risk.
• Drinks: A high consumption of alcohol and drinks high in fructose, a type of sugar, can increase the risk.
• Food: Foods containing purines can raise uric acid levels. They include red meat and some seafood.
• Body mass: Having obesity is a risk factor.

To diagnose RA or gout, a doctor will carry out a physical examination and ask about the person’s:

• medical history, including family history and any other chronic conditions
• symptoms and where they are in the body
• dietary habits

A doctor will also order blood testing. A uric acid test can help identify gout. Other biomarkers may help indicate if a person has RA. They include:

• anti-cyclic citrullinated peptide
• C-reactive protein and ESR (erythrocyte sedimentation rate)
• rheumatoid factor

Imaging tests, such as X-ray and MRI scans, can detect:

• damage to soft tissue or bone
• a buildup of uric acid crystals around the joints
• signs of inflammation around the joints

A doctor may use a needle to remove fluid from a swollen joint to test for the presence of uric acid crystals that may indicate gout.

Correctly identifying RA or gout is important because the treatments are different. Treatment for both will aim to manage symptoms and prevent flares and disease progression.

Treatments for gout include:

• taking colchicine or probenecid to reduce uric acid levels in the body
• taking allopurinol to block the production of uric acid
• taking nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to manage inflammation, pain, and swelling
• making dietary changes to reduce the risk from trigger foods and drinks

Taking oral colchicine can help shorten an attack. It may take 24 hours to take effect. Colchicine, NSAIDs, and corticosteroids are most likely to be effective if the person takes them in the first 24 hours after an attack begins.

RA treatments and management strategies include:

• disease-modifying antirheumatic drugs (DMARDs)
• biologic response modifiers (biologics)
• physical activity
• lifestyle changes, such as avoiding or quitting smoking

Medications such as DMARDs and biologics interfere with the immune response. They may help prevent flares, a worsening of symptoms, and long-term damage. The Arthritis Foundation recommends early, aggressive treatment to reduce inflammation or prevent it from developing.

A person may need to try various medications before finding the ones that best manage their condition.

What are some foods to avoid with arthritis?

RA and gout are both forms of arthritis, but the causes, symptoms, and long-term effects are different. A person with RA may have a higher risk of developing gout than a person without it, possibly because they share some risk factors.

Gout usually affects one or a few joints to start with and often starts in the big toe. RA often involves several joints symmetrically and can impact many organs of the body.

Blood tests can help a doctor distinguish between gout and RA. An early and accurate diagnosis is essential for finding the right treatment and may help prevent each condition from worsening.