How can gout be differentiated from rheumatoid arthritis?

Question

Hello doctor,

I am 43 years old and have had a history of high uric acid for the past 13 years, with levels usually ranging from 8.5 to 9. I take Febuxostat 80 mg, which lowers my uric acid temporarily, but it tends to rise again. I have been experiencing pain and inflammation in my joints for a long time, with the pain coming and going. I am 5 feet 7 inches tall, and my weight was 220 pounds. Three years ago, I managed to reduce it to 178 pounds, but my current weight is 194 pounds. For the past five months, I have had pain in my right wrist, which improved two weeks ago when the pain subsided.

However, I now have pain in my right ankle (foot) that started yesterday. I am feeling really tired and am starting to think that it might not be gout, but possibly rheumatoid arthritis. I have been reading about it and would like to know what the difference is between rheumatoid arthritis and gout pain. My diet typically includes a lot of chicken, as I eat it almost every day. Currently, I am taking Voveran 75 mg for the pain. I tested negative for anti-CCP. Could you help me understand what might be causing the constant pain and how I can determine whether it is gout or another form of arthritis?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I went through your post, you want to know how to differentiate between gout and rheumatoid arthritis (RA). Well, with RA, once it starts, it usually does not resolve on its own unless treated. Medications need to be continued, and typically three types of drugs are required. In contrast, gout usually starts in one joint. When treated, it settles and provides some time without symptoms, during which you do not need medication. However, if you experience multiple gout attacks, it may progress to polyarticular gout, which can be harder to differentiate clinically.

To confirm the diagnosis, we typically need a small sample of fluid from the affected joint, which can be examined under a microscope to check for urate crystals. If the crystals are present, gout is confirmed. Another method is to perform a Power Doppler Ultrasound (PDUS) of the affected joint, done by an expert radiologist. This may reveal a snowstorm appearance, which confirms gout.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

Based on what you have described, it sounds like gout rather than rheumatoid arthritis. Gout typically affects one joint at a time, with flare-ups followed by periods of remission, which aligns with your experience. Rheumatoid arthritis, on the other hand, usually involves multiple joints and tends to be more persistent without treatment.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.

How can gout be differentiated from rheumatoid arthritis?

Joint pain: Is it gout or rheumatoid arthritis?