Arthritis affects millions of people worldwide and about 1 in 4 adults in the United States. Psoriatic arthritis (PsA) and gout are forms of arthritis that can cause pain, swelling, and worsening joint damage. Although PsA and gout may look similar, they are different conditions with different approaches to diagnosis and treatment.
PsA affects approximately 30 percent of people who have psoriasis, a condition known to cause discolored, scaly patches on the skin. In PsA, the immune system mistakenly attacks and damages cells in the joints. PsA can develop at any age, but it usually starts affecting people in their 30s through 50s. It can affect any joint in the body, including those in the spine, fingers, toes, and hips.
Gout, on the other hand, is a type of arthritis that results from the buildup of uric acid crystals in the joints. Urate crystals can form when you have high levels of uric acid in your blood. These urate crystals lead to inflammation and pain in the affected joint. Gout is more common in men than women, according to Mayo Clinic, and typically develops after the age of 40.
You can have PsA and gout at the same time. In fact, newer studies show that those living with PsA have an increased risk of developing gout. This article focuses on comparing the similarities and differences between the two conditions.
Common symptoms found in many forms of arthritis include:
However, this is where the similarities between PsA and gout end.
People with PsA usually say their pain is on both sides of their body, often in different sets of joints on each side (called asymmetric). The pain usually comes with fatigue and a decreased range of motion. PsA is an autoimmune disorder, which means that the immune system mistakenly attacks healthy tissues in the body. People with autoimmune diseases such as PsA often say that their symptoms are worse in the morning (“morning stiffness”) and get better with use throughout the day. In severe cases, PsA can lead to joint damage and disability.
Gout can also cause joint pain and stiffness, but it’s typically more severe and sudden than the pain associated with PsA. Gout usually affects one joint at a time, most commonly the big toe. The pain can be intense, and the affected joint may become red, warm, and swollen. Gout attacks often occur at night and can last for several days. The pain from gout can be so severe that even the weight of a light bed sheet is unbearable.
The exact cause of PsA is not fully understood, but it’s believed to be influenced by genetic and environmental factors. About 4 out of every 10 people with psoriasis or PsA have a family history of the condition.
Gout, on the other hand, is caused by an excess buildup of uric acid in the body. Uric acid is a waste product that is normally filtered out of the body by the kidneys. However, if the body produces too much uric acid or if the kidneys are not able to remove it quickly enough, the excess uric acid can build up and form crystals in the joints, leading to gout.
PsA and gout have different risk factors — factors that increase the risk of developing the condition.
For PsA, having psoriasis is the main risk factor. Other risk factors include:
A diet high in foods and beverages that lead to uric acid buildup is perhaps the main risk factor for gout. Some of these foods and drinks include red meat (beef, pork, etc.), shellfish, alcoholic beverages (especially beer), and sugar-sweetened drinks. These items can produce high amounts of uric acid, which increases the risk of gout.
Uric acid can also build up more easily if your kidneys are not working properly. People with kidney disease cannot clear uric acid as effectively and are more likely to develop gout. This is also true of people with heart failure on diuretic medications (drugs to increase the flow of urine to help your body get rid of salt and water).
Other factors that increase the risk of gout include higher body weight, certain medical conditions and medications, having a family history of gout, age, sex, and having had recent surgery.
Diagnosing PsA and gout requires a combination of a doctor’s physical examination, medical history, and diagnostic testing.
In a person with PsA, a doctor will look for signs of psoriasis like discolored, scaly plaques on the skin. They will also check for joint pain and stiffness and may order images with an X-ray or MRI to look for signs of joint damage.
To diagnose gout, a doctor will also perform a physical exam to check for joint inflammation and pain. Sometimes, experiencing symptoms unique to a gout flare (such as swelling and pain in your big toe after a big meaty meal) is enough for a doctor to make the diagnosis.
Your doctor may also order blood tests to check the levels of uric acid in your blood. If the levels are high, the doctor may order X-rays or ultrasounds to look for signs of uric acid buildup in your joints. However, it is common for people with gout to show normal uric acid levels in a blood test, especially during a flare, making diagnosis challenging at times.
Treatment for PsA and gout can vary depending on how severe the condition is. The goal of treatment for both types of arthritis is to reduce inflammation, relieve pain, and prevent further joint damage.
Pain management for PsA and gout can involve taking over-the-counter painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Corticosteroids, both in pill and injection form, can also help manage pain episodes.
Exercising, eating a healthy diet, and managing your stress can help reduce the risk for both PsA and gout. Because a diet high in red meat, sugar, and alcohol can trigger gout attacks, a balanced diet can help reduce the risk of gout.
Because PsA is an autoimmune disease, medications specific to PsA may target the immune cells that attack your joints, slowing inflammation and preventing further joint damage. These drugs are called disease-modifying antirheumatic drugs (DMARDs) or biologic drugs (“biologics”). The most common DMARD is methotrexate, which is used for many different autoimmune conditions. Common biologic drugs include adalimumab (Humira) and secukinumab (Cosentyx).
Gout treatment focuses on helping the body get rid of uric acid. This is the goal of long-term medications such as allopurinol and febuxostat, which help clear uric acid from the body and prevent future gout attacks.
PsA and gout can be complex. Proper treatment planning often involves specialists known as rheumatologists, who treat patients with autoimmune and joint conditions.
We encourage you to bring up questions about PsA or gout during your next visit with your rheumatologist. If you have either condition, make sure to keep regular appointments, so your health care provider can work with you to create an effective treatment plan catered to your needs.
MyPsoriasisTeam is the social network for people with PsA (and psoriasis in general) and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and its complications.
Are you or a loved one living with PsA or gout? How do you manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.