Rheumatoid Arthritis vs. Gout: How to Know the Difference

Medically Reviewed by Carol DerSarkissian, MD on April 06, 2022
3 min read

Rheumatoid arthritis (RA) and gout have a lot in common. Doctors consider them types of arthritis. That means that both cause swelling, pain, and stiffness in joints. But there are important differences between them, too.

Those differences include why they happen. There are also telltale differences in their symptoms that help to distinguish the two. Because the causes are different, doctors also manage and treat them in different ways.

Rheumatoid arthritis and gout both are types of arthritis, but the underlying causes are completely different. RA is an autoimmune condition. It happens when your body’s immune system attacks the tissue that lines your joints. This attack causes painful swelling, inflammation, and joint deformity. Since RA is an immune system disease (your doctor will call it an autoimmune condition), it can affect other parts of the body, too, including the skin, eyes, and heart.

Gout affects people with too much uric acid in their blood. Your body creates this type of acid when it breaks down certain foods, including meat. Your kidneys normally get rid of it when you pee. But when there’s too much of it in your system, the uric acid can form crystals. These needle shaped crystals build up in joints and surrounding tissue where they can cause pain and inflammation.

Both gout and RA can cause pain and stiffness in multiple joints. But otherwise the two tend to follow different patterns.

Rheumatoid arthritis. This condition usually starts in smaller joints like your hands and feet. They’ll feel tender, swollen, and warm to the touch. Then it usually moves to other, larger joints like your wrists, elbows, shoulders, ankles, knees, and hips. It’s rare, but you might also have fatigue and loss of appetite or a fever, though that’s less likely.

Most people have similar symptoms on both sides of the body. That means if one shoulder hurts, the other one probably does, too.

RA can make your joints feel stiff when you wake up in the morning. The pain may get better with activity over the course of the day.

Gout. Unlike RA, it usually starts with a sudden attack of pain. The pain can be severe. It isn’t unusual for a person with gout to feel like their joint is on fire. It might feel like there’s a hot poker in the joint.

Gout usually affects only one joint. The big toe is a common spot, but gout also can affect ankles, knees, elbows, or wrists.

The affected joint also might look red and swollen. It may be warm to the touch. Sometimes a gout attack can cause a fever.

Neither RA nor gout is curable. But there are treatments to help manage your symptoms. Some are the same for either condition:

  • Pain treatments. Over-the-counter pain relievers like ibuprofen and naproxen can help with either condition. A medication called colchicine can also ease gout pain.
  • Inflammation treatments. Corticosteroids like prednisone can help with inflammation and the pain it causes.

When it comes to treating the underlying disease, doctors focus their efforts on treating the cause. RA treatment may include drugs that suppress the immune system.

Gout treatment usually includes medications that prevent the buildup of uric acid crystals.

What you eat can also affect the levels of uric acid in your blood. If you have gout, take these steps to prevent an attack of gout:

Yes. Doctors used to think that people with RA didn’t get gout. But they’ve since realized that isn’t true. The two are distinct conditions. So it’s possible for a person to have both.

If you or a loved one are having joint pain and don’t know why, it’s a good idea to see a doctor. They can check your joints and test your blood and joint fluid to find the cause and decide the next steps.