What Is Rheumatoid Arthritis vs. Gout?

Symptoms of rheumatoid arthritis may include:

• Joint pain and stiffness
  • Usually in the small joints, such as those joints at the base of the fingers, the middle of the fingers, and the base of the toes, or may occur in a single, large joint, such as the knee or shoulder, or it may shift from one joint to another
  • Usually affects the same joints on both sides of the body (symmetrical)
  • Pain may develop gradually
• Fatigue
• Muscle pain
• Low-grade fever
• Weight loss
• Numbness and tingling in the hands
• Feeling unwell (malaise) 

As RA progresses, joint pain and inflammation become more prominent and symptoms include: 

• Joint pain and stiffness that may affect the:
  • Hands
    • Carpal tunnel syndrome: weakness, tingling, and numbness in the hand and fingers
    • Finger deformities/bent fingers 
  • Wrist: difficulty bending the wrist backward
  • Elbow: numbness or tingling in the fingers
  • Shoulder: pain and limited motion
  • Foot
    • Standing and walking with weight on the heels due to tenderness at the joints at the base of the toes 
    • Top of the foot may be swollen and red, and the heel may be painful.
  • Ankle: nerve damage that can lead to numbness and tingling in the foot
  • Knee: difficulty bending the knee and a “Baker's cyst” (fluid-filled cyst in the space at the back of the knee)
  • Hips: difficulty walking
  • Neck: painful and stiff neck, difficulty bending the neck and turning the head
  • Cricoarytenoid joint (a joint near the windpipe): hoarseness and difficulty breathing
• Other symptoms of rheumatoid arthritis may include:
  • Decreased bone density
  • Muscle weakness 
  • Skin problems: rheumatoid nodules (painless lumps that appear beneath the skin) 
  • Eye problems: eye redness, pain, and vision problems
  • Lung disease: shortness of breath and a dry cough
  • Pericarditis: chest pain and difficulty breathing
  • Vasculitis: inflammation of the blood vessels
  • Sjögren's syndrome: dry eyes and dry mouth

Symptoms of gout attacks (flares) include: 

• Sudden episodes of severe joint pain
  • Pain can feel like a hot poker in the joint
  • Usually involves redness, swelling, heat, and tenderness of the joint
  • Typically affects a single joint, but some people can develop several inflamed joints at the same time
  • Common in the big toe, and also in lesser toe joints, ankle, and knee
  • Tends to occur more often during the night and early morning than during the day, though can occur any time
  • Pain and inflammation are at their worst within 12 to 24 hours and usually go away completely within a few days to several weeks, even if untreated
• May be accompanied by fever 

The causes of rheumatoid arthritis and gout are different.

The cause of rheumatoid arthritis is unknown but it is thought that certain factors may affect a person's risk of developing the condition such as: 

• Age: middle-aged or older
• Female sex: twice as likely as men to develop RA
• Genetics: people with a relative who has RA have an increased risk of developing the condition

Triggers that may increase the chances a susceptible person will develop the disease include:

• Infection: bacteria in the gut or mouth and gum infection (periodontitis) in particular 
• Smoking 
• Stress 

Gout is usually caused by too much uric acid in the body (hyperuricemia). When there is excess uric acid in the body, uric acid crystals (monosodium urate) can accumulate in the joints, fluids, and tissues of the body. Hyperuricemia does not always cause gout, and hyperuricemia without gout symptoms does not require treatment.

Risk factors for developing gout include:

• Obesity
• Certain health conditions, including: 
  • Congestive heart failure
  • high blood pressure (hypertension)
  • Insulin resistance
  • Metabolic syndrome
  • Diabetes
  • Chronic kidney disease/poor kidney function
• Overeating or prolonged fasting
• Consuming large amounts of meat or seafood
• Excessive and regular consumption of alcohol (especially beer, vodka, whiskey, gin, or rum) 
• Consuming beverages containing high fructose corn syrup (such as regular sodas)
• Use of medications that affect blood levels of urate, such as diuretics (water pills)
• Being male
• Having a diet high in purines, which the body breaks down into uric acid
  • Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna

The diagnosis of rheumatoid arthritis uses a combination of clinical, laboratory, and imaging information. 

Laboratory studies used to diagnose rheumatoid arthritis include:

• Erythrocyte sedimentation rate 
• C-reactive protein level 
• Complete blood count 
• Rheumatoid factor (RF) assay 
• Antinuclear antibody assay 
• Anti-cyclic citrullinated peptide and anti−mutated citrullinated vimentin assays 

Imaging studies used to diagnose rheumatoid arthritis include:

• X-rays (first choice) of the joints
• Magnetic resonance imaging (MRI)
• Ultrasound of joints

Joint aspiration and analysis of synovial fluid may also be indicated:

Gout can only be diagnosed during a flare when a joint is hot, swollen, and painful, and when the fluid lining the affected joint (synovial fluid) is examined under a microscope to check for urate crystals.

If a synovial fluid analysis is not possible, criteria that may be used to help diagnose gout include:

• Joint pain and inflammation that develops rapidly, initially involving one joint at a time, especially the joint at the base of the large toe
• Complete remission of symptoms between flares
• High levels of urate in the blood

Rheumatoid arthritis and gout are both treated with medications such as: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Corticosteroids 

Other medications used to treat rheumatoid arthritis include:

• Nonbiologic disease-modifying antirheumatic drugs (DMARDS) 
• Biologic tumor necrosis factor (TNF)-inhibiting DMARDs 
• Biologic non-TNF DMARDs 
• Pain relievers (analgesics)
• Topical skin products

Other treatments for rheumatoid arthritis include:

• Heat and cold therapies 
• Orthotics and splints 
• Physical therapy and exercise 
• Occupational therapy 
• Adaptive equipment 
• Joint-protection education 
• Energy-conservation education 
• Surgery

Treatment of gout flares is aimed at reduction of pain and inflammation, and is usually short-term and limited to the duration of the flare. 

Medications used to treat gout flares include anti-inflammatory medications:

• Colchicine (Colcrys)

For people who have tophi (clumps of uric acid crystals around a joint) and kidney stones, medications include: 

• Allopurinol (Zyloprim)
• Febuxostat (Uloric, Adenuric)
• Pegloticase (Krystexxa)