This gout & rheumatoid arthritis report is a layman’s summary of an investigation into the coexistence of gout and rheumatoid arthritis presented at the 2012 ACR meeting. With additional notes about key differences between rheumatoid arthritis and gout revealed by ultrasound.

Rheumatoid Arthritis

Rheumatoid Arthritis is a prolonged and progressive disease in which the immune system attacks the joints. Symptoms of rheumatoid arthritis include:

  • Pain, inflammation and swelling of the joints
  • Stiffness
  • Weakness
  • Loss of mobility
  • Deformity

Tissues throughout the body can be affected, including:

  • Skin
  • Blood vessels
  • Heart
  • Lungs
  • Muscles

Gout & Rheumatoid Arthritis Study

This is my layman’s summary of a study explaining the co-existence of gout and rheumatoid arthritis[1].

Gout & Rheumatoid Arthritis Study: Background/Purpose

It is popularly believed that gout does not occur in rheumatoid arthritis patients, yet some cases have been reported in medical press.

This investigation assesses the numbers, symptoms, and possible causes of gout in rheumatoid arthritis patients.

Gout & Rheumatoid Arthritis Study: Methods

Rheumatoid arthritis patients were selected between 1980 and 2007. Their medical history was followed until April 2012. From these subjects, patients with confirmed gout were analyzed. Gout was confirmed by the presence of uric acid crystals in joint fluid, or other established criteria, and excluded patients with:

  • Pseudogout
  • Hyperuricemia without gout
  • Septic arthritis
  • Traumatic arthritis
  • Rheumatoid arthritis initially misdiagnosed as having gout

Total gout cases in rheumatoid arthritis patients were analyzed statistically.

Gout & Rheumatoid Arthritis Study: Results

A study total of 813 patients had the following symptoms:

  • 537 (66%) were rheumatoid factor positive
  • 33% had rheumatoid nodules
  • 53% had erosive joint disease

These patients had an average 12 years rheumatoid arthritis, representing 9771 total person-years in the study. 22 patients developed gout by clinical criteria. The great toe was the most common site of gout (12 of 22 patients). The 25 year cumulative incidence of gout diagnosed by clinical criteria was 5.3%.

Typical uric acid crystals were present in 9 of 22 patients with acute gout. All had developed gout after first getting diagnosed with rheumatoid arthritis.

The 25-year cumulative incidence of gout diagnosed by clinical criteria including presence of urate crystals is 1.3%. The prevalence of gout in rheumatoid arthritis on Jan 1, 2008, was 1.9% (11 of 582 patients) as opposed to expected prevalence of 5.2% (or 30 patients) based on National Health and Nutrition Examination Survey (NHANES) data using age and sex-specific prevalence rates.

Risk factors for gout in rheumatoid arthritis were:

  • older age (1.5 more likely per 10 year increase)
  • male sex (3.18 more likely than female)
  • obesity (3.5 more likely)

The presence of erosive rheumatoid arthritis joint disease reduced the risk of gout to slightly less than one quarter.

Gout has become 5.6 times more common in patients diagnosed with rheumatoid arthritis in recent years (1995-2007) than in previous years (1980-1994).

Gout & Rheumatoid Arthritis Study: Conclusion

Gout does occur in patients with rheumatoid arthritis, though at a lower rate than in the general population. The minimum/maximum cumulative incidence is 1.3/5.3%.

Risk factors for gout in rheumatoid arthritis are similar to those in the general population.

Do you have Rheumatoid Arthritis with Gout?

Gout & Rheumatoid Arthritis: Next Steps

If you suspect that you have gout at the same time as rheumatoid arthritis, it is important to consult a rheumatologist.

Leave Gout & Rheumatoid Arthritis to browse other rheumatology research


Gout & Rheumatoid Arthritis Comments

GoutPal visitor responses and associated research include:

Ultrasound Differentiation Between Gout and Rheumatoid Arthritis

Recently, a suspected rheumatoid arthritis sufferer was investigated using advanced ultrasound techniques[2]. That study explains how gout was diagnosed. Including a table showing ultrasound differences between gout and rheumatoid arthritis:

Tissue Gout Rheumatoid Arthritis
Joints (Articular involvement) Asymmetric Symmetric
Hyaline cartilage Double contour sign Diffuse thinning
Joint Fluid (Synovial fluid) Snowstorm appearance (acute phase) Anechoic
Soft tissue Bright dotted foci (hyperechoic stippled aggregates)
Skin lumps (Subcutaneous nodules) Hyperechoic heterogeneous mass with hyperechoic dots and hypoechoic halo Hypoechoic homogeneous mass with hypoechoic central area
Bone * Destructive bone erosion Bone erosion
Tendon disorder Multiple bright stippled foci of the tophus enveloping the tendon Tenosynovitis
Disorder of tendon or cartilage attachment to bone (Enthesopathy) Rare Rare

* The original text refers to “born” not “bone” – presumably a translation error.
If you would like to see a more complete explanation of this study, please tell me using the feedback form below. Or discuss it in the gout forum.

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Gout & Rheumatoid Arthritis References

  1. Jebakumar, A. J., Udayakumar, P. D., Crowson, C. S., & Matteson, E. L. (2013). Occurrence of gout in rheumatoid arthritis: it does happen! A population-based study. International journal of clinical rheumatology, 8(4), 433.
  2. Murayama, Michito, Mutsumi Nishida, Yusuke Kudo, Takahiro Deguchi, Katsuji Marukawa, Yuichiro Fujieda, Nobuya Abe et al. “Case with long-standing gout showing various ultrasonographic features caused by monosodium urate monohydrate crystal deposition.” Modern Rheumatology Case Reports 4, no. 1 (2020): 110-115.

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