Gout and rheumatoid arthritis (RA) are types of arthritis or joint inflammation. While there are some similarities in symptoms between the two conditions, they also have some unique symptoms, as well as different causes, diagnostic tests, and treatments. Doctors rely on several clues to tell the difference between rheumatoid arthritis (RA) and gout, including the patient’s age, lifestyle factors, symptoms, blood tests, and imaging tests. Once the condition is properly diagnosed, it can be treated appropriately. According to the Spanish Foundation for Rheumatology “In Spain, it is estimated that 1 in 4 people over the age of 20 suffers from some rheumatic pathology, which represents nearly 11 million people affected”, according to the EPISER study from the same foundation. It has been estimated that about 880,000 people have gout and nearly 300,000 have rheumatoid arthritis. What is the difference between rheumatoid arthritis and gout? Rheumatoid arthritis is an autoimmune disorder, which means it is a condition in which the body’s immune system mistakenly attacks its own tissues. It is a chronic inflammatory disease characterized by inflammation and pain in the joints. Symptoms usually include hot, swollen, tender joints with stiffness in the morning or after a period of inactivity. Additional symptoms may include fatigue, fever, and loss of appetite. Joint pain associated with rheumatoid arthritis tends to start in the small joints of the hands and feet and is usually symmetrical (present on both sides of the body). RA can later spread to larger joints such as the wrists, elbows, knees, ankles, shoulders, and hips as the disease progresses. Gout is a type of arthritis characterized by sudden, severe joint pain, often in the big toe. Gout can also develop in the fingers, wrists, elbows, and knees. It occurs when uric acid crystals accumulate in a joint, causing intense pain and inflammation. These crystals form in the joints when uric acid levels in the blood are high. Certain foods and beverages such as red meat, shellfish, and alcohol promote high levels of uric acid in the body. Gout is characterized by sudden, severe joint pain, often in the big toe Getty Images/iStockphoto Gout causes the affected joint to become hot, swollen, red and tender. This is often described by patients as a hot poker in the joint. Unlike RA, gout symptoms are rarely symmetrical. Gout can affect a different joint with each outbreak. Fever is also much more likely with gout. Another characteristic of gout is the development of tophi in the joints. Tophi are small, hard lumps that are collections of uric acid. CausesAlthough they are both types of arthritis, the causes of gout and rheumatoid arthritis are very different. • Gout Gout is caused by hyperuricemia, that is, there is too much uric acid present in the body. When a person has hyperuricemia, uric acid crystals can build up in the joints, causing pain, swelling, and other symptoms of gout. Uric acid is produced when purines, a natural substance found in some foods, break down in the body. Due to this process, some factors can lead to an increase in uric acid. Uric acid is processed by the kidneys, and if someone has kidney problems, such as chronic kidney disease, they may not be processing uric acid correctly. Environmental factors such as a diet rich in purines (found in certain foods such as red meat or alcohol) can also lead to increased uric acid and gout. Also, certain genes and medications (most often diuretics) can affect the way a person processes uric acid, leading to gout. • Rheumatoid Arthritis Rheumatoid arthritis is different from other types of arthritis because it is an autoimmune condition. In autoimmune conditions, the body’s immune system attacks itself. For people with RA, the immune system attacks the soft tissues around the joints, creating inflammation, pain, swelling, and joint deformity. It is not exactly known why some people develop autoimmune diseases like RA and others do not. Researchers believe that RA may be caused by a combination of genetic, sex hormonal, and environmental factors. Treatment It is essential to receive an accurate diagnosis of gout or RA, because treatments vary between the two conditions. It is particularly important to diagnose rheumatoid arthritis in its early stages so that treatment can be started to prevent joint deformity and loss of function. • Gout Gout treatment can differ from person to person, but the goal is usually to reduce the pain and frequency of gout flare-ups. Some treatments your doctor may recommend include: 1 Medications: These may be over-the-counter (OTC) pain relievers, prescription anti-inflammatory medications, and/or urate-lowering medications. 2 Diet modifications: Changing your diet to eliminate or reduce purines can help reduce uric acid and treat gout. Your treating doctor may refer you to a dietitian/nutritionist to help you with this change. High-purine foods to avoid include beer, red meat, yeast extracts, organ meats, and certain types of shellfish. • Rheumatoid Arthritis RA must be treated quickly to prevent further joint or organ damage. Treatments will vary from person to person, but may include: 1 Medications – These may include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and prescription medications, including anti-inflammatories, corticosteroids, disease-modifying antirheumatic drugs (DMARDs) (including biological response modifiers) and Janus kinase (JAK) inhibitors. 2 Occupational Therapy: Occupational therapists, particularly certified manual therapists, often work with people with RA to promote joint integrity with gentle exercises, prevent joint deformity by creating custom splinting and wear schedules, and provide education on modifying activities to reduce your pain and keep it involved in daily life. 3 Ongoing monitoring – It is important to see your rheumatologist regularly to monitor how your medications and treatments are working and change your treatment plan as needed. 4 Surgery: Joint repair or replacement is usually a last resort, but may be recommended in certain cases. Can rheumatoid arthritis be confused with gout? Doctors usually don’t have much trouble differentiating between gout and rheumatoid arthritis. This is because gout attacks are often evident with severe joint pain. This is in contrast to RA, where the pain tends to be more insidious at onset. In addition to symptoms, the patient’s age and gender also provide clues. Rheumatoid arthritis can affect anyone, but it is much more common in women during their reproductive years. Gout tends to occur in two age groups: late 20s or early 30s and 70s and 80s, and is more common in men than women. RA must be treated quickly to prevent further damage to the joints or other organs. Getty Images/iStockphoto High levels of uric acid in the blood of a patient with gout symptoms are considered diagnostic of gout. There is no specific blood test for rheumatoid arthritis. Doctors check for the presence of certain antibodies such as antinuclear antibodies, anti-CCP (anti-cyclic citrullinated peptide) antibodies, and rheumatoid factor that can point toward a diagnosis of RA. They also check for anemia, which is common in patients with rheumatoid arthritis. Imaging tests such as X-rays can help doctors make the diagnosis of RA versus gout. Tophi can sometimes be seen on x-rays. However, the patient’s symptoms, physical examination, and blood uric acid levels are sufficient to make a diagnosis of gout. This information does not replace in any case the diagnosis or prescription by a doctor. It is important to go to a specialist when symptoms appear in case of illness and never self-medicate. Read also Laura Hernández Read also Raquel Saez Read also Guiomar Rovelló