Gout vs. Rheumatoid Arthritis: What Are the Differences?

Two Different Types of Arthritis

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Gout and rheumatoid arthritis (RA) are both 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.

Read on to learn more about the differences between gout and rheumatoid arthritis.

Close-up of unrecognizable woman sitting in living room holding hand in pain

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Symptoms

Naturally, gout and RA share some similar symptoms because they are both types of arthritis. These shared symptoms include:

  • Joint swelling
  • Joint pain
  • Occasional loss of joint function

Gout and RA also have their own unique symptoms, which can help you and your healthcare provider differentiate between the two conditions.

Symptoms of RA can include:

  • Symmetry of symptoms (pain and swelling occurs on both sides of the body)
  • Increased joint pain, swelling, and stiffness in the mornings
  • Symptoms that improve with gentle movement
  • Symptoms that worsen gradually over time
  • Fatigue

Symptoms of gout can include:

  • Asymmetry of symptoms (pain and swelling may occur on only one side of the body)
  • Pain often, but not always, starts in one of the big toes
  • Tophi (uric acid crystals which create taut bumps around joints)
  • Sudden onset of pain (flares), especially at night, with periods of remission
  • Fever

Causes

Although they are both types of arthritis, the causes of gout and rheumatoid arthritis are very different.

Gout

Gout is caused by hyperuricemia. Hyperuricemia means that there is too much uric acid present in the body.

When a person has hyperuricemia, uric acid crystals can collect in joints and cause pain, swelling, and other gout symptoms. Uric acid is produced when purines, a natural substance found in some foods, are broken down in the body.

Due to this process, a few factors can lead to an increase in uric acid. Uric acid is processed by the kidneys, and if someone is having kidney issues, such as chronic kidney disease, they may not be properly processing uric acid.

Environmental factors like a diet high in purines (found in certain foods like red meat or alcohol) can also lead to increased uric acid and gout.

Additionally, certain genes and medications (most often diuretics) can affect how a person processes uric acid, which leads 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 those with RA, the immune system attacks the soft tissues around the joints, creating inflammation, pain, swelling, and joint deformity.

It is not precisely known why some people develop autoimmune conditions like RA and others do not. Researchers believe that RA may be caused by a combination of genetics, sex hormones, and environmental factors.

Parts of the Body Affected by RA

In addition to the joints, rheumatoid arthritis can also affect other body parts such as the heart, lungs, and eyes.

Diagnosis

Diagnosis of gout or RA typically begins with a visit to your regular healthcare provider, who may refer you to a rheumatologist, a doctor who specializes in arthritis.

For both conditions, a rheumatologist will gather your health history, a list of symptoms, and perform an examination of your joints, looking for swelling or deformity.

There are also some specific tests for both gout and RA that can lead to a diagnosis.

Gout

Gout can only be correctly diagnosed during a gout flare, when the joints are swollen and painful. In some cases, a rheumatologist may be able to diagnose you based on symptoms and visual examination alone.

However, there are some diagnostic tests that can also indicate gout, which can be useful to help differentiate gout from other types of arthritis.

Synovial fluid analysis is considered the gold standard for gout diagnosis. Your healthcare provider will use a needle to withdraw the synovial fluid, which is a thick liquid within your joints. Then, they will examine this fluid under a microscope to look for uric acid crystals, which indicates gout.

Other tests that may be used to diagnose gout look for joint damage, hyperuricemia, and kidney damage. These can include:

Rheumatoid Arthritis

Similar to other autoimmune diseases, RA can be tricky to diagnose. It can present much like other conditions early on, and there is not just one single test that can diagnose it.

Some tests that a rheumatologist might run when diagnosing RA include:

Using the results of these tests, in combination with your symptom history and duration, your rheumatologist will make a diagnosis based on the 2010 ACR/EULAR Classification Criteria. This is the most recent diagnostic criteria for rheumatoid arthritis. It is a point-based system. A result of six to 10 points indicates RA, with higher points noting a higher degree of confidence that RA is the cause of your symptoms.

Treatment

It's essential to receive an accurate diagnosis of gout or RA, because treatments vary between the two conditions. It's 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 may differ from person to person, but the goal is typically to reduce pain and frequency of gout flares.

Some treatments your healthcare provider may recommend include:

  • Medications: These may be over-the-counter (OTC) pain relief drugs, prescription anti-inflammatory drugs, and/or urate-lowering drugs.
  • Dietary modifications: Changing your diet to eliminate or reduce purines can help lower your uric acid and treat gout. Your healthcare provider may refer you to a dietitian to aid in this change. Foods high in purines that you should avoid include beer, red meat, yeast extracts, organ meats, and certain types of seafood.

Gout and Diet

Researchers warn that while obesity and a high-purine diet can lead to hyperuricemia and gout, the main contributor to hyperuricemia is genetics. Therefore, dietary changes are important but often insufficient on their own to treat gout, and they should be considered in combination with medication.

Shaming people into adopting a "gout-friendly" diet is rarely successful and should be avoided.

Rheumatoid Arthritis

RA should be treated as a matter of urgency to prevent further joint or organ damage. Treatments will vary from person to person, but can include:

  • Medication: These may include OTC nonsteroidal anti-inflammatory drugs (NSAIDs) and prescription drugs including anti-inflammatories, corticosteroids, disease-modifying antirheumatic drugs (DMARDs) (including biologic response modifiers), and Janus kinase (JAK) inhibitors.
  • Occupational therapy (OT): Occupational therapists, particularly certified hand therapists, often work with people with RA to promote joint integrity with gentle exercises, prevent joint deformity by creating customized splints and wearing schedules, and provide education on activity modification to reduce your pain and keep you engaged in daily life.
  • Ongoing monitoring: It's important to regularly check in with your primary healthcare provider or rheumatologist to monitor how your medications and treatments are working and change your treatment plan as needed.
  • Surgery: Joint repair or replacement is usually a last resort but may be recommended in certain cases.

Prevention

Genetics and other factors outside your control can contribute to both gout and rheumatoid arthritis. However, there are some lifestyle changes you can make to prevent both conditions.

Keep in mind that making these changes can reduce your chances of developing gout or RA, but it doesn't mean you should blame yourself if you do develop the condition.

Gout

Since gout is a result of hyperuricemia, gout prevention focuses on reducing the uric acid in your body. You can help prevent gout, or future gout flares, by:

  • Losing weight
  • Making dietary changes (reducing purine intake)
  • Limiting alcohol
  • Managing stress

Rheumatoid Arthritis

Because it is an autoimmune disease, rheumatoid arthritis prevention techniques may not completely stop you from developing the condition, but they may delay symptom onset and reduce severity.

Prevention focuses on altering or eliminating your risk factors, including:

  • Quitting smoking
  • Supporting bone health
  • Limiting alcohol
  • Keeping up with gentle, low-impact exercise
  • Eating more fish
  • Maintaining oral health

Summary

Although they are both types of arthritis, there are many differences between gout and rheumatoid arthritis. These include their causes, diagnostic and treatment options, and prevention measures. While they are different conditions with different pathologies, both RA and gout can cause intense joint pain and impact your daily life.

A Word From Verywell

Joint issues can be painful and uncomfortable. If you are experiencing joint pain, talk to your healthcare provider about a diagnosis and treatment options. Because treatment varies between gout and RA, be very thorough in describing your symptoms. It may help to visit a healthcare provider during a flare to ensure an accurate diagnosis.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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