Gout and OA—What’s the Connection?

A swollen, stiff knee might immediately lead you to suspect you have osteoarthritis (OA), but the culprit could also be gout. Like many close relatives, the two conditions share common features. And because they often occur together, you might wonder which one is causing your symptoms.

“It’s definitely possible for people to have both conditions at the same time. They’re the two most common types of arthritis,” says Svetlana Krasnokutsky, MD, assistant professor of medicine in the Division of Rheumatology at NYU Langone Health. “They can affect the same joints.”

OA is a degenerative disease that gradually breaks down the cartilage that cushions bones. It causes pain, swelling, and stiffness in joints like the knees, hips, fingers, lower back, and neck. In gout, uric acid crystals build up in the joints. Gout often affects the big toe joint, but the ankles, knees, hands, and wrists can also be involved.

Knowing which condition you have—or whether you’ve got both gout and osteoarthritis —can help your doctor fine-tune your treatment.

Which Comes First?

Doctors know that gout and OA often coexist. What researchers have been trying to figure out is which one comes first, and whether one condition might trigger the other.

A 2007 study published in Annals of the Rheumatic Diseases found that people with uric acid deposits in their joints—especially in joints of the big toe, middle of the foot, knee, and finger—are more likely to have OA in those same joints. Those with gout are also at greater risk for severe OA. Researchers say uric acid crystals might activate an inflammatory response that triggers OA joint damage.

On the flip side, people with osteoarthritis are at higher risk for developing gout. One theory is that joint damage from OA creates an environment that encourages uric acid deposits.

“One [condition] could promote the other, and it could go both ways,” Dr. Krasnokutsky says. The same inflammatory processes that damage joints could underlie both OA and gout. And the two conditions share a few common risk factors—including obesity. Extra weight both increases production of uric acid, and puts more strain on joints.

Making the Diagnosis

Although gout and osteoarthritis can affect the same joints—sometimes at the same time—there are ways for your doctor to tell them apart. Gout tends to come on suddenly with attacks of pain, swelling, warmth, and redness in a single joint—often the big toe joint. “OA tends to be more chronic, waxing and waning, but not so abruptly as gout in terms of its onset,” Dr. Krasnokutsky says.

If symptoms alone don’t identify the cause of your joint pain, your doctor can dig deeper with tests. Removing a small amount of fluid from the affected joint can find the uric acid crystals that form in gout. And imaging tests like X-rays and MRI can reveal joint damage typical of OA.

Treating Gout and OA

Some treatments for gout and osteoarthritis overlap. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Morin) and naproxen sodium (Aleve) can help to alleviate symptoms like pain and swelling in both conditions. Gout is primarily treated with medicines that lower uric acid production.

“For gout, we have very good treatments for the underlying cause,” Dr. Krasnokutsky says. “With OA there are many underlying causes…so you’re treating the end result of the OA, which is pain and functional limitation, but you’re not necessarily getting to any root cause.”

Lifestyle is another important component in treating both conditions. For gout, doctors recommend avoiding or limiting high-purine foods and alcohol, because they can increase uric acid levels. “Those are practical, good suggestions for gout patients, and probably for everyone,” Dr. Krasnokusky says.  For OA, weight loss can help to reduce pressure on painful joints and therapeutic exercise, such as yoga and tai chi can ease pain and protect range of motion.

AUTHOR: Stephanie Watson

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