Gout Attack in Big Toe

Rheumatoid arthritis (RA) and gout are both inflammatory forms of arthritis that can cause joint pain, swelling, and visible nodules. Although the conditions have completely different causes — RA is an autoimmune condition, whereas gout stems from excess levels uric acid — even doctors sometimes have a hard time distinguishing between the two. (Here’s more information on symptoms of gout vs. symptoms of rheumatoid arthritis.)

To further add to the confusion, it’s also possible to have RA and gout at the same time, though until fairly recently experts though this combination was unlikely.

In 2013, a study published in the International Journal of Clinical Rheumatology — aptly titled, “Occurrence of Gout in Rheumatoid Arthritis: It Does Happen!” — concluded that RA patients do develop gout, but at a much lower rate compared to the general population.

Now a new study, published in the journal Arthritis Care & Research, suggests that RA patients may be just as likely to develop gout as anybody else. The authors, who examined data on nearly 2,000 patients from the multicenter Veterans Affairs Rheumatoid Arthritis (VARA) registry, found that that 6.1 percent of RA patients also had gout.

About 4 percent of the general population has gout, but it breaks down to 6 percent of men and 2 percent of women. (Ninety percent of the VARA participants are male.)

The new Arthritis Care & Research study also found that 17 percent of RA patients had elevated amounts of uric acid in their blood, indicating that they are at higher risk of developing gout in the future. Gout occurs when the body does not excrete excess uric acid properly; instead, it forms crystals that can settle in the joints. This number is also similar to what’s found in the general population.

“Taken together, these results counter the notion that RA or its treatment provides meaningful protection against the development of [elevated uric acid] leading to gout,” the researchers wrote.

That’s important for a few reasons. Firstly, if you have gout, you will need specific treatment aimed at lowering your uric acid levels; RA medication won’t do that. Also concerning is that hyperuricemia (excess uric acid) “has been associated with cardiovascular and renal disease,” the authors noted.

People who have RA already face a high risk of heart disease; a patient who has gout as well as RA may be in even greater danger.

If you have RA and risk factors for gout, it’s a good idea to talk to your doctor about this potential overlap. When you have one type of arthritis, it’s easy to assume new or unusual symptoms are just a different manifestation of that, rather than an additional diagnosis, so it’s important to be aware of what to look out for in case you start to experience any gout symptoms.

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