Gout and osteoarthritis

What is the difference between gout and osteoarthritis?

Both cause joint pain, but they are two separate conditions and their treatment differs.

Gout is a type of arthritis in which a joint suddenly becomes very painful. The NHS writes that the cause is a high level of uric acid in the blood, which can form crystals in the joint. It runs in families and is more common in men and with increasing age. Obesity, alcohol, menopause, some medicines (such as diuretics and some blood pressure medicines), high blood pressure and high blood fats, kidney problems and diabetes are risk factors.

Osteoarthritis is the most common type of arthritis. The NHS describes it as wearing of the cartilage at the ends of the bones, which causes pain, stiffness and reduced movement. It mostly affects the knees, hips and small joints of the hand. The risk rises with age, previous joint injury, family history and being overweight, and it is more common in women.

Symptoms

Gout:

• Sudden, severe pain, usually in the big toe, although the joints of the foot, ankle, hand, elbow and knee can also be affected.
• The joint is hot, swollen and red (the redness is less visible on dark skin).
• The NHS says an untreated attack usually lasts one to two weeks.
• Triggers: a feverish illness, heavy drinking or a very large meal, dehydration, joint injury and some medicines.

Osteoarthritis:

• Joint pain that gets worse with use, stiffness, difficulty moving, and sometimes swelling, tenderness or a grating sound.
• Severity varies from person to person. Some cases are mild and occasional, others constant and disruptive to daily life.
• Morning stiffness is either absent or lasts less than 30 minutes (NHS).

Who should see a doctor?

• If this is the first time you have had pain like this in a joint, or your usual treatment is not working, see a doctor (NHS).
• The Arthritis Foundation recommends booking an appointment if joint symptoms last three days or more, or come back several times in a month.
• If the joint pain and swelling are getting worse, or you have a fever and chills, act the same day (see the last section).

How is it assessed?

Gout: The NHS writes that the doctor takes a history (including about diet and alcohol), measures the uric acid level in the blood and, if the result is not clear, may refer you to a rheumatologist for a sample of joint fluid or an ultrasound.

Osteoarthritis: The NHS says the doctor usually makes the diagnosis by asking about your symptoms and examining the joint. An X-ray or blood test is usually not needed and is mostly used to rule out other causes, such as rheumatoid arthritis or a fracture.

What does treatment look like in general?

Gout (NHS):

• During an attack: usually anti-inflammatory medicines (NSAIDs) and, if they do not work, steroids as tablets or an injection.
• For prevention: if attacks are frequent or uric acid is high, a medicine that lowers uric acid, which must be taken regularly, even without symptoms.
• Long-term untreated gout can damage the joint and cause painful lumps under the skin (tophi) and kidney stones.

Osteoarthritis (NHS):

• Mild symptoms: regular exercise, weight control, suitable footwear and aids.
• More severe symptoms: painkillers and an exercise programme with a physiotherapist.
• Surgery only for a small number of patients.

What can you do?

During a gout attack (NHS): start the prescribed medicine early (it should work within two days), rest the joint and keep it raised, put an ice pack wrapped in a towel on it for up to twenty minutes, drink enough fluids unless your doctor has said otherwise, and avoid putting pressure on the joint.

To reduce later attacks (NHS): lose weight gradually (not crash diets), eat a healthy diet with fewer sugary drinks and foods, limit alcohol, drink enough water, exercise regularly without putting too much strain on the joints, and stop smoking.

For osteoarthritis (NHS): 150 minutes of moderate aerobic activity a week, such as cycling or brisk walking, and strength training on at least two days a week; a suitable weight; good posture and less sitting still. Being overweight puts a lot of strain on the knees and hips.

For any particular medicine or supplement, talk to your doctor before taking it.

When to get help urgently

• One joint suddenly becomes very painful, hot and swollen and you have a fever, or you have chills, feel generally unwell and cannot eat. The NHS says these can be signs of a joint infection (septic arthritis), which needs urgent treatment. Contact a doctor the same day, and if you cannot reach one, go to the emergency department. The NHS says the risk is higher in people with rheumatoid arthritis or a weakened immune system, and after surgery or with an artificial joint.
• The joint pain and swelling are getting worse. See a doctor the same day.

See the full list in the guide “When should I call urgently?”