Refresher: Is it arthritis or gout?

Gout and arthritis are both painful conditions that cause inflammation of the peripheral joints, and the nodules of rheumatoid arthritis and the tophi of gout can be similar in appearance—but their causes and treatment differ.Compiled from resoources includiung the American Rheumatology Association, Canadian Arthritis Society, Canadian Rheumatology Association, Arthritis Society of Canada, The Mayo Clinic and MedlinePlus, here's what clinicians needs to remember when examining for these two conditions.Overview of differences Arthritis is a broad term encompassing over 100 different types of joint inflammation and diseasesCauses vary widely among types and can include autoimmune responses, wear and tear, infections and metabolic imbalancesIt generally involves inflammation and degeneration of the joints, leading to pain and stiffness Gout is a specific type of arthritis known as crystal-induced arthritisIt occurs due to the accumulation of uric acid crystals in the jointsIt is a form of inflammatory arthritis characterized by sudden and severe attacks of painGout is the most common form of inflammatory arthritis, affecting as many as 1 million Canadians, affecting more males than females (4% to 1%), according to the Arthritis Society of CanadaCauses and Risk FactorsCauses for arthritis vary depending on the type, according to the Arthritis Society of Canada:Osteoarthritis (OA): Wear and tear on the jointsRheumatoid Arthritis (RA): Autoimmune response attacking joint tissuesPsoriatic Arthritis: Associated with the skin condition psoriasisInfectious Arthritis: Caused by infections in the joint(See Arthritis Society of Canada for a full list of arthritis types and causes.)Arthritis risk factors: Older ageSex (most types of arthritis are more common in women)GeneticsObesity, especially knee and hip osteoarthritisPrevious joint injury or occupations or activities that stress the joints for osteoarthritisThe primary cause of gout is high levels of uric acid in the blood (hyperuricemia) lead to the formation of urate crystals. Uric acid crystals in soft tissues are usually found under the skin and form hard bumps with a white chalk-like colour. When they are present, these crystal deposits, called tophi [toe-fi] can usually be seen around the ears and around extensor tendons, which are found in hands and feet. Uric acid crystals in joints can be responsible for gout attacks.Gout risk factors:Diet high in purines (e.g., red meat, seafood)Alcohol consumptionObesityGeneticsCertain medications (e.g., diuretics)SymptomsArthritisPain: Varies in intensity and can be chronic. Pain may increase with activityLocation: Can affect any joint, often multiple jointsSwelling and Redness: Common in inflammatory types like RA, less common in OAStiffness: Particularly in the morning or after periods of inactivityDeformity: In severe cases, joint deformity may occur, especially in RAGoutPain: Intense and sudden, often described as excruciating. Usually affects one joint at a timeLocation: Commonly affects the big toe, but can also affect ankles, knees, elbows, wrists and fingersSwelling and Redness: The affected joint often becomes red, swollen, and warmOnset: Symptoms often begin at night and may wake the patient from sleepDiagnosisArthritisBlood tests: Can indicate inflammation markers and specific antibodies (e.g., rheumatoid factor for RA)Joint fluid test: To rule out infections or goutImaging: X-rays, MRI, or ultrasound to observe joint damage and inflammationGoutBlood test: Measures uric acid levelsJoint fluid test: Identifies urate crystals in the joint fluidImaging: X-rays, ultrasound, or CT scans to detect crystal depositsTreatmentArthritisMedications:Pain relief: NSAIDs, acetaminophenInflammation Control: disease-modifying antirheumatic drugs (DMARDs) for RA, biologicsPhysical therapy: Exercise to strengthen muscles around jointsLifestyle Changes: weight management, low-impact activitiesSurgery: joint replacement or repair in severe casesGoutMedications:Acute attacks: NSAIDs, colchicine, corticosteroidsLong-term: Medications to lower uric acid levels (e.g., allopurinol, febuxostat)Diet and Lifestyle:Reduce intake of purine-rich foodsIncrease hydrationMaintain a healthy weightAvoiding Triggers: alcohol, certain medicationsPrognosisArthritisPrognosis varies widely:OA: Progressive but manageable with lifestyle changes and treatmentRA: Chronic, potentially disabling, but manageable with modern treatmentsComplications: Chronic pain, joint damage, disability, systemic involvement in RAGoutGenerally good prognosis with proper management of uric acid levels. Chronic gout can lead to joint damage if not treatedComplications: Chronic gouty arthritis, kidney stones, tophi formationPreventionArthritisHealthy lifestyle: Regular exercise, maintaining a healthy weightJoint protection: Using joint-friendly techniques and equipmentEarly intervention: Treating infections promptly and managing autoimmune conditions effectivelyGoutDietary modifications: Avoiding high-purine foods and alcoholHydration: Adequate fluid intakeWeight management: Maintaining a healthy body weight

Refresher: Is it arthritis or gout?

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