Many doctors believe that patients with rheumatoid arthritis can’t get gout, but according to a new study, that long held belief apparently isn’t true.
A study by researchers at the Mayo Clinic appears to show that rheumatoid arthritis (RA) patients aren’t immune to what lead author Eric Mattesondescribes as the nation’s “obesity-fueled gout epidemic.”
The reason doctors thought that rheumatoid arthritis patients didn’t get gout likely had to do with the way the way they used to be treated. RA patients were once given high doses of aspirin, which helped their kidneys expel the uric acid that causes gout.
Aspirin is no longer widely used to treat rheumatoid arthritis and that, combined with a rise in obesity, is likely fueling gout in rheumatoid arthritis patients.
“It is probably true that flares of rheumatoid arthritis in some cases might have actually been flares of gout, and that the gout wasn’t diagnosed,” said Dr. Matteson, who chairs the Division of Rheumatology at Mayo Clinic in Rochester, Minn.
The two conditions are both very painful, but are treated differently.
Rheumatoid arthritis is an autoimmune disease, in which the immune system mistakenly attacks tissues. causing inflammation in joints. Disease-modifying anti-rheumatic drugscan slow the progression of RA, while immuno-suppressants act to tame the immune system. RA affects more than 1.3 million Americans.
In gout, the body produces too much uric acid or has problems flushing it out, causing urate crystals to build up in the joints. Nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen are often used to control the inflammation and pain, along with corticosteroids like prednisone.
Although a few cases in the scientific literature reported patients with both gout and rheumatoid arthritis, Dr. Matteson found that the prevailing belief in the medical community was that they didn’t coexist.
Operating under the assumption there was a connection, Dr. Matteson said his research team studied the case histories of over 800 patients diagnosed with rheumatoid arthritis between 1980 and 2007. The patients were all part of the Rochester Epidemiology Project, a pool of patient medical records from various health care providers in the area.
Defying conventional wisdom, what they found was that gout does occur in patients with RA, although at a lower rate than the general population.
Twenty-two patients developed gout over the study period, most often in the big toe. It was more common in patients diagnosed with RA after 1995. The risk factors for gout were the same as in the general population: being overweight, older and male.
“Awareness that gout does exist in patients with rheumatoid arthritis hopefully will lead to better management of gout in those patients,” said Dr. Matteson.
More than 8 million Americans suffer from gout, an inflammatory arthritis of the joints that causes excruciating pain and swelling. One of the most common symptoms of gout is waking up at night feeling like your big toe is on fire.
Gout attacks can also include swelling, redness, intense pain, and tenderness that can radiate to the ankle, foot, and knees. Gout attacks can last from several days to weeks, and each subsequent attack becomes more painful.