Gout is a type of arthritis that causes sudden and severe attacks of pain, swelling, redness and warmth in one or more joints. It usually affects the big toe, but can also affect other joints such as the ankle, knee, wrist, elbow and fingers. Gout occurs when uric acid, a waste product that normally dissolves in the blood and passes out of the body in urine, builds up in the body and forms crystals in the joints. These crystals trigger inflammation and pain in the affected joint.
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Arthritis is a general term for a group of conditions that cause joint inflammation and damage. There are many types of arthritis, such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, lupus and ankylosing spondylitis. Arthritis can affect any joint in the body and cause symptoms such as pain, stiffness, swelling, reduced range of motion and deformity.
Gout and arthritis have some similarities and differences. In this article, we will explore how gout and arthritis are related, what causes them, how they are diagnosed and treated, and how to prevent them.
How are gout and arthritis related?
Gout is a form of inflammatory arthritis, which means it is caused by an abnormal immune response that leads to inflammation in the joints. Other types of inflammatory arthritis include rheumatoid arthritis, osteoarthritis, psoriatic arthritis, lupus and ankylosing spondylitis. These conditions share some common features, such as:
They can affect people of any age, gender and ethnicity
They can cause chronic or intermittent joint pain and stiffness
They can affect multiple joints or organs in the body
They can increase the risk of other health problems, such as cardiovascular disease, kidney disease and infections
They require long-term management with medication and lifestyle changes
However, gout and other types of inflammatory arthritis also have some distinct differences, such as:
Gout is triggered by high levels of uric acid in the blood, while other types of inflammatory arthritis are triggered by genetic or environmental factors that affect the immune system
Gout usually affects one joint at a time, while other types of inflammatory arthritis can affect several joints at once
Gout attacks are sudden and severe, while other types of inflammatory arthritis cause gradual and persistent symptoms
Gout can be diagnosed by testing the fluid from the affected joint for uric acid crystals, while other types of inflammatory arthritis require blood tests or imaging tests to diagnose
Gout can be treated by lowering the uric acid level in the blood with medication or diet changes, while other types of inflammatory arthritis require medication to suppress the immune system or reduce inflammation
What causes gout and arthritis?
The exact causes of gout and arthritis are not fully understood, but they involve a combination of genetic and environmental factors that affect the metabolism or the immune system.
Gout is caused by high levels of uric acid in the blood. Uric acid is a waste product that results from the breakdown of purines, which are substances found in certain foods (such as red meat, seafood, organ meats and alcohol) and in the body's own cells. Normally, uric acid dissolves in the blood and passes out of the body in urine. However, if the body produces too much uric acid or excretes too little uric acid, it can accumulate in the blood and form crystals in the joints. These crystals trigger an inflammatory response that causes pain and swelling in the affected joint.
Some factors that can increase the risk of developing gout include:
Genetics: Some people inherit a tendency to produce more uric acid or excrete less uric acid than others
Diet: Eating foods high in purines or fructose can increase the uric acid level in the blood
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Alcohol: Drinking alcohol can interfere with the excretion of uric acid and increase its production
Obesity: Being overweight can increase the production of uric acid and reduce its excretion
Medications: Some medications can increase the uric acid level in the blood or impair its excretion, such as diuretics (water pills), aspirin (low doses), niacin (vitamin B3), cyclosporine (an immunosuppressant) and some cancer drugs
Medical conditions: Some medical conditions can increase the production or reduce the excretion of uric acid, such as kidney disease, diabetes, high blood pressure, high cholesterol, thyroid disorders and psoriasis
Arthritis is caused by an abnormal immune response that leads to inflammation and damage in the joints. The immune system is a complex network of cells and molecules that protect the body from foreign invaders such as bacteria and viruses. However, sometimes the immune system malfunctions and attacks its own tissues instead. This causes chronic inflammation that can damage the joints and other organs in the body.
Some factors that can increase the risk of developing arthritis include:
Genetics: Some people inherit genes that make them more susceptible to developing certain types of arthritis, such as rheumatoid arthritis, psoriatic arthritis, lupus and ankylosing spondylitis
Environment: Some environmental factors can trigger or worsen the immune response that causes arthritis, such as infections, stress, smoking, pollution and diet
Hormones: Some hormones can influence the development or progression of arthritis, such as estrogen, which may explain why women are more likely to develop rheumatoid arthritis and lupus than men
Age: The risk of developing arthritis increases with age, as the joints and the immune system wear out over time
Injury: Trauma or overuse of the joints can damage the cartilage and bone and trigger inflammation that leads to arthritis
How are gout and arthritis diagnosed?
The diagnosis of gout and arthritis depends on the symptoms, physical examination, laboratory tests and imaging tests.
Gout is diagnosed by testing the fluid from the affected joint for uric acid crystals. This is done by inserting a needle into the joint and withdrawing some fluid for analysis under a microscope. The presence of needle-shaped crystals that are negatively birefringent (meaning they appear yellow when aligned parallel to a polarized light source and blue when aligned perpendicular to it) confirms the diagnosis of gout.
Other tests that can help diagnose gout include:
Blood tests: To measure the level of uric acid in the blood and to rule out other causes of joint inflammation, such as infection or rheumatoid arthritis
Urine tests: To measure the amount of uric acid excreted in the urine and to check for kidney problems
X-rays: To assess the extent of joint damage or deformity caused by gout
Ultrasound: To detect uric acid crystals in the soft tissues around the joint
Arthritis is diagnosed by a combination of blood tests and imaging tests. There is no single test that can diagnose all types of arthritis, but some common tests include:
Blood tests: To measure markers of inflammation (such as erythrocyte sedimentation rate or C-reactive protein), antibodies (such as rheumatoid factor or anti-cyclic citrullinated peptide), autoantibodies (such as antinuclear antibody or anti-double stranded DNA), or genetic markers (such as HLA-B27)
X-rays: To assess the extent of joint damage or deformity caused by arthritis
MRI: To detect inflammation or damage in the soft tissues around the joint, such as tendons, ligaments, cartilage and bone marrow
Ultrasound: To detect inflammation or damage in the synovium (the lining of the joint) or fluid accumulation in the joint
Joint aspiration: To obtain fluid from the joint for analysis under a microscope or for culture to identify any infection
How are gout and arthritis treated?
The treatment of gout and arthritis aims to reduce pain, inflammation, joint damage and complications. The treatment options depend on the type, severity and frequency of symptoms, as well as the patient's preferences and overall health.
Gout is treated by lowering the uric acid level in the blood with medication or diet changes. This can prevent future attacks of gout and reduce the risk of joint damage and kidney stones. Some common medications for gout include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen, naproxen or indomethacin, to reduce pain and inflammation during an acute attack of gout
Colchicine: A plant-derived drug that inhibits the formation of uric acid crystals and reduces inflammation in the joint
Corticosteroids: Such as prednisone or methylprednisolone, to reduce pain and inflammation in severe cases of gout or when NSAIDs or colchicine are not tolerated or contraindicated
Uricosuric agents: Such as probenecid or sulfinpyrazone, to increase the excretion of uric acid in the urine
Xanthine oxidase inhibitors: Such as allopurinol or febuxostat, to decrease the production of uric acid in the body
Pegloticase: A biologic drug that converts uric acid into a harmless substance that can be easily eliminated by the body
Diet changes that can help lower the uric acid level in the blood include:
Avoiding foods high in purines, such as red meat, seafood, organ meats and alcohol
Drinking plenty of water to dilute the uric acid concentration in the urine and prevent kidney stones
Eating foods low in purines, such as fruits, vegetables, whole grains, low-fat dairy products and nuts
Limiting foods high in fructose, such as sugary drinks, honey and processed foods
Key Takeaways
Gout is a form of inflammatory arthritis caused by excess uric acid in the blood forming crystals in the joints
Arthritis refers to over 100 joint conditions, the most common being osteoarthritis and rheumatoid arthritis
Both gout and arthritis cause joint inflammation, pain, swelling and damage over time
Gout occurs in sudden attacks while arthritis has a more gradual onset
Gout is diagnosed by seeing uric acid crystals in joint fluid under a microscope
Treatment focuses on managing symptoms and preventing future attacks or progression
Lifestyle changes and adhering to prescribed treatment help prevent recurrent flares
FAQs
Here are some frequently asked questions about gout and arthritis:
Q: Is gout a type of arthritis?
A: Yes, gout is a form of inflammatory arthritis where attacks are triggered by uric acid crystals forming in the joints. The crystal deposition causes inflammation that clinically appears like arthritis.
Q: Can you have gout and osteoarthritis?
A: Yes, it's possible to have both gout and osteoarthritis. Gout is caused by high uric acid while osteoarthritis is wear-and-tear damage to the joint cartilage and bone. The two conditions sometimes co-occur, especially in older adults.
Q: Does rheumatoid arthritis cause gout?
A: No, rheumatoid arthritis doesn't directly cause gout. However, some rheumatoid arthritis medications like diuretics can increase uric acid levels and potentially trigger gout attacks in susceptible individuals.
Q: Can gout turn into rheumatoid arthritis?
A: No, gout does not turn into or cause rheumatoid arthritis. They are distinct conditions with different underlying causes - uric acid crystals in gout and an autoimmune attack on joints in rheumatoid arthritis. Proper diagnosis and treatment can help manage both conditions.
Q: What's the difference between septic arthritis and gout?
A: Septic arthritis is joint inflammation caused by an infection while gout is caused by uric acid crystals. Septic arthritis occurs with fever and has a rapid onset while gout attacks are not associated with infection. Joint fluid analysis helps differentiate between the two.