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Gout May Be Your Second Arthritis

This inflammatory condition can occur with osteoarthritis, rheumatoid arthritis and psoriatic arthritis.

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That pain in your knee might be from your osteoarthritis (OA). Then again, it might be from gout you didn’t realize you have. It is possible to have more than one type of arthritis, and knowing what you have can help in treating your symptoms. Gout, which can occur with OA, rheumatoid arthritis (RA) and psoriatic arthritis (PsA), results when uric acid crystals are deposited in joint tissue. It causes sudden, severe pain, swelling and tenderness, usually in the big toe, but it also can occur in the feet, ankles, hands, knees, wrists, elbows or other joints. It’s typically in only one joint, but chronic gout can affect multiple joints.

“Differentiating between gout and other forms of arthritis is critical because the treatments are so different. Misdiagnosis could be a real disservice to the patient,” says Alan Baer, MD, director of the Johns Hopkins University Gout Clinic. If you think you’ve got gout, see your doctor. The sooner it’s treated, the sooner you’ll get pain relief.

Here’s how gout may affect other types of arthritis.

Gout and RA

For decades, rheumatoid arthritis and gout were thought to be mutually exclusive. But a 2013 Mayo Clinic study shows that more than 2 percent of people with RA also get gout. The percentage of people with both has increased over the past three decades, probably as a result of the rise in gout risk factors, including obesity, high blood pressure and kidney disease. Diagnostic tools like synovial fluid analysis and dual-energy CT scans are especially helpful in making the correct diagnosis.

Gout and OA

Though osteoarthritis and gout often go hand in hand, there’s a “chicken versus egg” dilemma, says Dr. Baer. OA’s joint damage might create a hospitable environment for gout’s characteristic uric acid crystals to deposit. Or the crystals may cause inflammation, making joints more susceptible to cartilage breakdown typical of OA. No matter which comes first, being overweight is a common risk factor for gout and OA, so be sure to maintain a healthy weight.

Gout and PsA

Some of the risk factors for psoriatic arthritis overlap with gout’s, such as obesity. Uric acid levels tend to be higher in gout patients who also have PsA, because it accumulates with the rapid skin cell turnover involved in psoriasis. This risk-factor overlap increases chances of developing both conditions.

A 2014 study showed that people with psoriasis and psoriatic arthritis have a five times higher gout risk than people without the two conditions.

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