Gout May Be Your Second Arthritis

Reviewed May 11, 2022

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 osteoarthritis (OA) or autoimmune, inflammatory forms of arthritis, including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), results when uric acid builds up and forms crystals that 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 often very different. (If you think you have gout, see your doctor. The sooner it’s treated, the sooner you’ll get pain relief.) However, gout can also occur along with other forms of arthritis, including these.

Gout and Rheumatoid Arthritis

For decades, rheumatoid arthritis and gout were thought to be mutually exclusive, but it has become clear that some people with RA also get gout. A study published in 2020 involving 2,000 patients with RA found that 17% also had gout. These patients were older, mostly male and had co-existing high blood pressure and heart disease — common conditions in both RA and gout. These conditions also raised their risk of early death than people without gout.

Gout and Osteoarthritis

Though osteoarthritis (OA) and gout often go hand in hand, there’s a question of which might cause the other. 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 both gout and OA, so strive to maintain a healthy weight.

Gout and Psoriatic Arthritis

Psoriatic arthritis (PsA) and gout also share obesity as a risk factor, and uric acid levels tend to be higher in gout patients who also have PsA. But in a 2020 review article published in Clinical Rheumatology, French researchers propose that the relationship between the two diseases is far more complex — so complex and intertwined that they’ve dubbed it “psout.” They suggest high uric acid contributes to PsA and that rather than two separate conditions, gout and PsA overlap — a type of inflammatory arthritis in which patients have symptoms of several distinct immune diseases. They also suggest it might be possible to treat PsA with uric acid-lowering drugs used to treat gout. While the two diseases have many commonalities, more research is needed to define the relationship between them.

Gout and Ankylosing Spondylitis

Similarly, it used to be believed that having gout and ankylosing spondylitis (AS) at the same time was rare, but a 2019 study published in Rheumatology International found that people with AS have gout more commonly that those who don’t have AS. The study included data on 3,763 AS patients and 19,214 without AS. Of them, nearly 2% of AS patients had gout compared with just over .5% of those without AS, leading the authors to conclude that gout is not less common with AS and may be more common, especially in men and in those between 40 and 60 years old. Ankylosing spondylitis was more common in smokers and those with hypertension; however, gout was more common in AS patients with a body mass index in the normal range, under 25.