Gout and rheumatoid arthritis

Question: I am a 50-year-old man recently diagnosed with rheumatoid arthritis (RA). But I have had joint symptoms for some time, beginning two years ago with a bout of excruciating pain and swelling in my left toe and progressing to episodes of pain and swelling in my feet, knees and wrists. While these incidents may have been early signs of rheumatoid arthritis, gout is also a concern of mine. Do you think I have arthritis or gout?
Answer: It sounds to me like you have gout, an inflammatory disease that occurs when excess uric acid (a bodily waste product) circulating in the bloodstream is deposited as sodium urate crystals in certain joints.
The excess uric acid may be caused by genetic factors or kidney disease. The condition may be aggravated by certain drugs such as diuretics or by consuming too much alcohol or foods rich in purines, which are broken down into uric acid.
If your physician didn’t know about your previous problems, it’s not surprising he diagnosed your condition as rheumatoid arthritis. In its later stages, gout can look a lot like RA, causing pain and inflammation in multiple joints.
But the causes and treatments are entirely different. Unlike gouty arthritis, RA occurs when the body’s immune system mistakenly attacks the thin membrane that lines the joints. RA may begin acutely in many joints or start gradually in several joints causing damage and pain.
Gout, on the other hand, often starts as your problem did – with excruciating pain and swelling in the big toe – and often follows a trauma such as an illness or injury. Subsequent attacks may occur off and on in other joints – primarily those of the foot and knee – before becoming chronic. In its chronic stage, gout can affect many joints, but this can take a few years to happen.
Gout is a well-understood and highly treatable disease. Medications are available to stabilize uric acid levels and relieve acute pain and inflammation. With appropriate treatment gout can be controlled and future flares prevented. Taking the proper medications and taking them faithfully – even during periods when you feel absolutely fine – is essential to controlling gout. Maintaining a reasonable weight and limiting alcohol consumption can help control gout as well.
If you haven’t already had a joint fluid sample examined for urate crystals, I would recommend you speak to your doctor about having one at your next visit. Or if the medication he has prescribed for your RA (and I assume he has prescribed one or more) doesn’t seem to be helping, schedule a visit sooner. It is important to determine whether you have rheumatoid arthritis or gout – the sooner you know and begin proper treatment, the sooner you will experience relief.
Doyt Conn, MD
Professor of Medicine
Emory University School of Medicine
Atlanta, Georgia

Rheumatoid Arthritis and Gout: What’s the Difference?

By Theodore Fields, MD, CreakyJoints Adviser

Arthritis awareness advocates have been busy! May is Arthritis Awareness Month, and today, May 22, is Gout Awareness Day. Like rheumatoid arthritis (RA), gout is known for symptoms such as joint pain, swelling, and stiffness. You may have heard of gout and its symptoms, but do you understand the true impact of this rheumatic disease?

Rheumatoid Arthritis vs. Gout

We don’t know the exact cause of rheumatoid arthritis, but we know that changes in some of the body’s proteins can set off activation of the immune system, which leads to the release of multiple inflammatory chemicals (cytokines) that cause joint inflammation and damage, with swelling, warmth, tenderness, and discomfort.

Gout Causes and Symptoms

On the other hand, gout is an inflammatory type of arthritis that is caused when there is too much uric acid in the body. Uric acid, a normal waste product formed during the breakdown of certain foods, is usually eliminated by the body as urine. But if too much uric acid builds up or cannot be filtered by the kidneys, acid crystals form in the joints. Our immune system sees the crystals as “foreign bodies” and attacks them as it would a splinter, causing local inflammation, redness, heat, and a lot of pain.

CreakyJoints recently conducted a comprehensive survey of people with gout and their caregivers that revealed how much of an impact this condition has on people living with it, as well as on their loved ones.

For example:

  • Employed gout patients surveyed reported missing an average of 6.3 days of work in the last year because of painful gout attacks.
  • Caregivers who are employed missed almost five days because they had to provide care or assistance to a loved one experiencing a painful gout attack.
  • Nearly 70 percent of patients surveyed said gout has a negative impact on their family; 74 percent of caregivers agree.

These shocking findings make it clear that gout not only impacts patients, but it also takes a toll on caregivers.

RELATED: Don’t miss these lifestyle tips from people who have RA. Find answers on Tippi.

How to Distinguish Gout From RA

It can be confusing to tell the difference between RA and gout, so here is some helpful background information to help distinguish between the two:

1. Which joints are involved?

Gout is most common in the big toe, at the joint where the toe meets the foot. Gout is also common at the ankles, midfoot, knees, and elbows. It is usually in later stages of gout when small joints in the hands are involved. RA, however, tends to involve the smaller joints in the hands early on. The pattern of joint involvement is very helpful to physicians in differentiating between gout and RA.

2. What does a gout attack feel like?

If someone thinks they are getting a gout attack, they should look out for the joint’s turning red, which is more common in gout than in RA. While RA is painful, a gout attack is often so intense that the sufferer has great difficulty walking. People with RA can have difficulty walking as well, but the sudden intensity and immediate loss of function is usually more dramatic in gout. The onset of RA pain is more gradual, while the pain from gout generally reaches its peak within 24 hours.

The duration of gout flares is typically limited even without treatment — lasting two weeks or less — but RA flares usually last longer unless treated. Most gout patients are in so much pain, however, that they need to be treated and can’t wait for the flare to quiet down by itself. In fact, the pain from a gout flare can be so excruciating that, in the CreakyJoints survey, 44 percent of female gout patients with children agreed with the statement that gout attacks are “more painful than childbirth.”

3. What is a “uric acid level,” and why is it important?

If you’re experiencing joint pain that seems like possible gout, it would be helpful to get your blood uric acid level tested by your physician. If your uric acid levels are high and your symptoms are similar to those described above, gout is very likely. If the diagnosis of gout is not clear, fluid can be removed from a swollen joint and the uric acid crystals can be seen under a microscope. Once crystals are seen, the diagnosis of gout is made.

Yet often, the symptoms, exam, and uric acid levels make the diagnosis of gout extremely clear, and examination of the fluid for crystals is not needed. The American College of Rheumatology recommends that patients with gout achieve a target blood uric acid level below 6 milligrams per deciliter (mg/dL). Keeping the level below 6 over time leads to complete resolution of gout flares for the vast majority of people.

Luckily, gout is an extremely treatable condition, so getting a proper diagnosis and appropriate management is critical. For more information, please visit CreakyJoints.org/goutsurvey.

Theodore Fields, MD, is an adviser to CreakyJoints and the clinical director of the Inflammatory Arthritis Center’s Early Arthritis Initiative at the Hospital for Special Surgery in New York City. CreakyJoints is an online community of patients and families looking for arthritis resources and support. Founded in 1999, it now includes more than 100,000 arthritis patients and their families. To learn more and to join for free, go to CreakyJoints.org.

Photo Credit: (2)

Gout vs. Rheumatoid Arthritis: What’s the Difference?

At first glance, it might seem like gout and rheumatoid arthritis aren’t so different. Both cause pain, swelling, and stiffness of the joints that can limit your range of motion. However, the cause differs. RA is an autoimmune disease, which means the body’s own immune system attacks the joints, whereas the pain of gout is due to elevated levels of uric acid in the blood. But despite some similarities in symptoms, rheumatologists usually don’t have much trouble telling the two conditions apart.

“Cases of gout are often clear-cut because the flash of pain patients experience during a flare is so dramatic,” says Kelly A. Portnoff, MD, a rheumatologist at The Portland Clinic in Portland, Oregon. “It feels like a hot poker in their joint. Whereas if you have RA, the pain kind of creeps up on you.”

A patient’s age also provides clues. While rheumatoid arthritis can affect almost anyone, it most often first appears in women in their reproductive years. Gout tends to arise in one of two life stages: the late twenties/early thirties and the seventies and eighties.

“When gout strikes earlier, it’s often due to lifestyle factors that promote high levels of uric acid, such as meat-heavy diet and excessive alcohol intake,” Dr. Portnoff says. When gout appears later in life, it’s more likely the result of kidney damage or health conditions that increase the risk of gout, such as high blood pressure, diabetes, and heart disease.

There are also some differences in the symptoms of gout and rheumatoid arthritis, as you’ll see below.

Common Symptoms of Gout

Pain that migrates: Gout usually affects the big toe, but it can also occur in the ankles, knees, elbows, wrists, and fingers. The symptoms are rarely symmetrical, and the location varies from flare to flare. For example, an attack in the left big toe might be followed by an attack in the right toe, and the next gout attack might strike one of the knees or wrists.

Fever: People with RA do sometimes experience a fever, but it’s much more commonly seen in those with gout, says Dr. Portnoff: “The burden of inflammation in a gout flare and the body’s robust response to it can be so great that it causes a fever.”

Tophi: Over time, people with chronic gout can develop tiny, hard lumps in the affected joints. These lumps, called tophi, are concentrations of uric acid crystals. They can also form in the kidneys and lead to kidney stones.

Common Symptoms of Rheumatoid Arthritis

Symmetrical symptoms: In RA, joint pain usually affects both sides of the body. Symptoms typically begin in the small joints in the hands and feet; as the disease progresses, pain can develop in the wrists, knees, ankles, elbows, hips, and shoulders.

Morning stiffness: The pain of RA is typically at its worst in the morning, which causes a period of stiffness that can last an hour or longer. Motion helps ease RA symptoms, so people generally feel better later in the day as they accumulate more activity.

Gout vs. Rheumatoid Arthritis: Getting the Correct Diagnosis

The Role of Blood Tests

With no definitive blood test available for RA, doctors instead look for certain antibodies in the blood that would suggest its presence, such as antinuclear antibodies, rheumatoid factor, and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Your rheumatologist will also order a complete blood count to see if you have anemia, which is common among those with RA.

“RA is more difficult to identify than gout because measuring the amount of uric acid in the blood is considered a definitive test for gout,” Dr. Portnoff says. However, levels of uric acid are actually lower during a gout flare, so your doctor will want to repeat the test when symptoms subside.

The Role of Imaging Tests

Both RA and gout can cause joint erosion, so rheumatologists will order X-rays to look for this. X-rays can also detect the beginnings of tophi, but Dr. Portnoff says they’re not an essential part of the diagnostic process for gout because a patient’s clinical history, physical exam, and uric acid testing will identify gout.

Getting Prompt Treatment for Gout or RA

If you’ve been experiencing symptoms of either condition, you should see your doctor as soon as possible because both can cause significant joint damage if a diagnosis is delayed. However, Dr. Portnoff notes that the pain gout causes is so intense that patients with gout rarely put off seeing a doctor when they’re having an attack. (Taking medication regularly to treat gout, even when you’re between attacks, is important though.)

There’s no cure for gout or RA, but there are several good treatments available for the two conditions. Some pain relief treatments, including NSAIDs and corticosteroids, are recommended to help manage both RA and gout. Because RA is an autoimmune disease, patients may also take disease-modifying immunosuppressant drugs such as methotrexate or other DMARDS (disease-modifying anti-rheumatic drugs) or biologics.

Gout, on the other hand, may be treated with the drug colchicine, which relieves pain and helps prevent future attacks. Rheumatologists may also prescribe drugs called xanthine oxidase inhibitors (which reduce the amount of uric acid your body makes), and sometimes combine those with medications called uricosuric drugs that improve your kidneys’ ability to remove uric acid from your body. People with gout are also advised to limit foods that promote high levels of uric acid, including red meat, alcohol, and shellfish. However, diet changes alone cannot usually control gout symptoms, and medications are necessary to help prevent complications.

Keep Reading

  • Lupus vs. Rheumatoid Arthritis: What’s the Difference?
  • This Is What Gout Does to Your Bones Even When You’re Not Having an Attack
  • Gout Home Remedies: Here’s What You Can (and Can’t) Do to Relieve Gout Pain Fast

Gout vs. Osteoarthritis

Signs and symptoms

  • OA stiffness tends to get worse with use throughout the day whereas stiffness due to gout is present only at the time of the attack.
  • OA is associated with asymmetrical (not “matching”) swelling in individual joints that are not part of a pair — e.g., one knee and an elbow, instead of both knees whereas Gout either involves a single joint or involves the joints in an asymmetric pattern.Generally, OA symptoms include joint stiffness, pain, and enlarged joints and it does not have any systemic symptoms.
  • On the other hand the patient having Gout suddenly experiences a hot, red, swollen joint, caused by the formation of uric acid crystals between the joints. The attack often occurs at night and in a single joint, with the pain becoming more severe. Chills and a mild fever along with a general feeling of malaise may also accompany the severe pain and inflammation.
  • In Gout although the pain and swelling disappear with treatment, it almost always returns in the same joint or in another one. Whereas OA is a continuous and progressive disease with no remissions.

Location of joints involved

With OA, inflammation generally occurs at the joint closest to your fingernail. On the other hand gout usually affects the joints in the big toe. Some other parts that could get affected by gout are ankle, heel, knee, wrist, fingers, elbow, etc.


Adult men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disorder before menopause. People who have had an organ transplant are more susceptible to gout.

OA is much more common than Gout. In the United States alone, an estimated 20 million people have osteoarthritis.

Nov. 4, 2013 (San Diego) — Rheumatoid arthritis and gout, another form of arthritis, may occur together, despite previous thinking that having both is rare, according to new research.

Based on the new findings, doctors should consider looking for gout in RA patients, says study researcher Christina Petsch of the University of Erlangen-Nuremberg in Germany.

Both are inflammatory conditions. You get gout when uric acid builds up in joints, bones, and tissue. Gouty arthritis causes inflammation in the joints, often in the big toe.

RA affects the joints, surrounding tissues, and sometimes other organs.

Petsch evaluated 100 men and women, average age 63, who’d been diagnosed with RA. On average, they had RA for nearly 9 years. All had high blood levels of uric acid.

Petsch used a scan to look for uric acid deposits in their feet. She found that 13% of the patients had positive scans.

Even though the scan was positive, it doesn’t mean for sure the patients have gout. The result could have been a false-positive.

Men were more likely to have both conditions than women.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.

Although the disease processes of gout and rheumatoid arthritis (RA) are quite different, both are characterized by redness, swelling, and pain in the joints that can cause serious disability. Differentiating gout from RA and other immune-mediated joint diseases can be difficult, especially if treatment is delayed.

“Gout usually presents with joints that become suddenly inflamed but return to normal in one or two weeks; however, in long-standing and poorly treated gout, one or several joints can become permanently inflamed,” says Francisca Sivera, MD, PhD, of the rheumatology department at Hospital General Universitario de Elda, in Spain. “If this is the case, the clinical picture of gout can mimic RA, and both diseases can be confused.”

What makes gout different from RA?

So what features of the 2 conditions can help clinicians tell them apart? A careful history and physical exam are an essential starting point, and often can provide suggestive clues such as the presence of tophi or rheumatoid nodules. X-ray findings of specific types of bony erosions can be helpful. Additionally, the diagnosis can be confirmed by joint aspiration in the case of gout, or supported by a positive rheumatoid factor or anti-cyclic citrullinated peptide tests in the case of RA. However, there are a number of situations in which the diagnosis may remain in doubt.

Gouty arthritis is frequently episodic and usually limited to one or a few joints early on. In later years, however, it can become a chronic process that affects many joints and may mimic RA. Monosodium urate aggregates (tophi) can form under the skin, which can, in rare patients, resemble the rheumatoid nodules that can occur in RA. In both gout and RA, the classic findings can be absent. RA patients can be seronegative, lacking the characteristic antibodies against citrullinated proteins. And while intracellular uric acid crystals in synovial fluid can be diagnostic of gout, that finding can be falsely negative if the sample is not evaluated closely or if there is a prolonged time between obtaining the sample and looking for the cells. Assessing the presence or absence of such deposits, serological markers of RA, and gouty erosions help distinguish polyarticular gout from RA. New imaging modalities like ultrasound (looking for a double contour sign) and dual energy CT (looking for monosodium urate deposits) are additional ways to evaluate for gout if other tests are insufficient.

Dr. Sivera notes that gout frequently has a nontypical presentation, however, with some patients experiencing multiple joint involvement, persistent arthritis, bursitis, and other symptoms. “For example, European recommendations state that the diagnosis of gout should be considered in all undiagnosed arthritis,” she explains. Dr. Sivera and her colleagues recently developed multinational, evidence-based clinical recommendations related to gout on behalf of the 3e (Evidence, Expertise, Exchange) Initiative, a multinational collaboration tasked with promoting evidence-based practice in rheumatology. The recommendations address diagnosis, comorbidity screening, treatment, lifestyle counseling, flare prophylaxis, and various other topics.1

The correct diagnosis matters

Differentiating gout from RA is essential because treatments for the two conditions are very different. “Patients need to be educated on the causes of the urate deposits and especially on the objective of treatment,” says Dr. Sivera. “The main aim when managing gout patients is to lower the serum uric acid levels through medications so that the deposits can slowly dissolve.”

But medication won’t change things overnight, she says: “Patients need to be warned of the risk of new flares from deposits that remain in the joints, need to have a management plan in case of flares, and need to be aware that having a new flare when initiating urate-lowering medication doesn’t mean that the medication isn’t working and should be stopped.”

Dr. Sivera points out, however, that there’s ample evidence that many physicians, including primary care practitioners and rheumatologists, aren’t doing a good job of adequately managing gout.2 Guidelines stress the importance of using a treat-to-target approach, as only a serum uric acid level below 6 mg/dL will allow urate deposits to dissolve.1

Does gout preclude the presence of RA, or vice versa?

To complicate the relationship between gout and RA further, recent research has pointed to the possibility of gout and RA in the same patient, which challenges older studies that suggested that gout doesn’t typically occur in individuals with RA.

“Looking into the literature, gout and rheumatoid arthritis seemed to be negatively related. But in the daily life setting, depending where the patient lives, the percentage of patients with rheumatoid arthritis and hyperuricemia is not that low,” says Jürgen Rech, MD, of the Department of Internal Medicine at the University of Erlangen-Nuremberg, in Germany. Hyperuricemia is a prerequisite for the deposition of monosodium urate crystals in tissues. “Therefore, the prevalence of gout in RA may be underdiagnosed,” Dr. Rech notes. One population-based study reported a 25-year cumulative prevalence of 5.3% for the coexistence of RA and gout.3

A recent study conducted by Dr. Rech and his colleagues found that a considerable number of patients with RA display periarticular monosodium urate crystal deposits, with most of these patients being seronegative, meaning that they lack anti-citrullinated protein antibodies. Every third seronegative RA patient had evidence of monosodium urate crystal deposits on dual-energy CT examination.4 It’s likely that an undefined proportion of these patients has long-standing polyarticular gout rather than RA, however.5

“Research that will help define the frequency of the coexistence of gout and RA—and of misdiagnosis—and that will clarify whether the coexistence of both diseases changes the presentation, the prognosis, or the response to treatment will be very welcome,” says Dr. Sivera.

Such studies—in addition to efforts aimed at raising awareness among clinicians and patients about the proper diagnosis, management, and prevention of gout—will likely provide significant benefits for patients who have, or are likely to develop, this painful yet treatable condition

Published: May 19, 2016

Rheumatoid Arthritis Patients Can Get Gout Too, Mayo Clinic Study Finds

WASHINGTON — Refuting a belief long held by many physicians, a Mayo Clinic study found that rheumatoid arthritis patients also can get gout. The research is among several studies Mayo Clinic is presenting at the American College of Rheumatology annual meeting in Washington. Researchers also found that gut bacteria has potential to treat autoimmune disorders, rheumatoid arthritis patients are at higher risk for cancer, broken bones put rheumatoid arthritis patients in greater danger of heart disease and death, and corticosteroids are a mainstay of rheumatoid arthritis treatment even as new drugs emerge.

VIDEO ALERT: For an interview with Dr. Matteson and Mayo Clinic News Network membership, visit the Mayo Clinic News Network.

The gout study shows that, contrary to conventional wisdom, rheumatoid arthritis patients aren’t immune to the nation’s obesity-fueled gout epidemic, says lead author Eric Matteson, M.D., chair of the Division of Rheumatology at Mayo Clinic in Rochester, Minn. The two are distinct conditions, treated differently. Rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks tissues, inflaming joints. In gout, the body produces too much uric acid or has problems flushing it out, and urate crystals build up in joints, causing inflammation and intense pain.

The reason it was thought that rheumatoid arthritis patients didn’t get gout likely had to do with the way rheumatoid arthritis used to be treated, Dr. Matteson says. Such patients used to be given aspirin in high doses, and that coincidentally helped their kidneys expel uric acid. Aspirin is no longer used much for rheumatoid arthritis, and that, combined with a rise in obesity, is likely fueling gout in rheumatoid arthritis patients, he says.

“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; it wasn’t realized that it was a coexistent problem,” Dr. Matteson says. “Awareness that gout does exist in patients with rheumatoid arthritis hopefully will lead to better management of gout in those patients.”

Researchers studied 813 patients diagnosed with rheumatoid arthritis between 1980 and 2007 and followed them as long as they were alive and in the county, until last April. The study used the Rochester Epidemiology Project, a National Institutes of Health-supported pool of Olmsted County, Minn., patient medical records from Mayo and other health care providers.

Twenty-two patients developed gout over the study period, most often in the big toe. Gout was more common in patients diagnosed with rheumatoid arthritis from 1995 on. The risk factors for gout were the same as in the general population: being overweight, being older and being male.

Other Mayo studies being presented at the rheumatology conference found that:
*Gut bacteria, specifically Prevotella histicola, have anti-inflammatory benefits that could help treat autoimmune disorders such as lupus, rheumatoid arthritis and ankylosing spondylitis. Researchers examined the possibility using mice, and more studies are planned. “This is a hot area of research now,” says Dr. Matteson, who wasn’t part of the study team.

*Corticosteroids, whose discovery at Mayo Clinic earned the Nobel Prize in 1950, are still a common treatment for rheumatoid arthritis even as newer drugs with fewer side effects emerge. The proportion of patients on the drugs at any given point in their rheumatoid arthritis is actually higher than it used to be, the study found. “Not only do we think that they’re helpful in controlling symptoms of disease, especially in the first year, but we also are realizing that they have some effect in modifying the disease course,” says Dr. Matteson, the lead author. “We try to use the minimum amount possible for the shortest time necessary.”

*Rheumatoid arthritis patients have a higher risk of developing blood cancers, particularly lymphoma. One of the immune system’s top jobs is to seek and destroy cancer cells, and in rheumatoid arthritis patients that can fail due to the autoimmune disorder itself and to drugs that treat it by suppressing the immune system, Dr. Matteson, the lead author, says. More research is needed to understand the risk factors in individual patients. A small number of patients get lymphoma, and they tend to have more severe rheumatoid arthritis, Dr. Matteson says.

*Rheumatoid arthritis patients who have cardiovascular disease are more likely to test positive for rheumatoid factor in their blood, and those who are positive for rheumatoid factor seem to have immune systems that age faster and also have accelerated risk of cardiovascular disease.

*Rheumatoid arthritis patients who have broken bones are at higher risk of cardiovascular disease and death. The chronic inflammation in rheumatoid arthritis may be a factor.

The following abstracts included conflict-of-interest disclosures: rheumatoid arthritis and gout; mortality after fragility fractures; accelerated aging; and fractures associated with increased risk of cardiovascular events. For more information, see the ACR abstract supplement.

Media Contact: Sharon Theimer, 507-284-5005 (days), [email protected]

Gout VS. Rheumatoid arthritis (RA). What is the difference?

Gout and rheumatoid arthritis (RA) are common bone and joint diseases mostly found in Thai population and worldwide. Since both types of orthopedic problems affect the joints and causing pain and inflammation, gout and rheumatoid arthritis (RA) can be generally confused with each another. Knowing the differences of these diseases helps to get accurate diagnosis and receive appropriate treatments in time.

Differences between Gout VS. Rheumatoid arthritis (RA)

Rheumatoid arthritis (RA)

Gout is an inflammatory disorder, but it is not an autoimmune condition. Gout is caused by high blood levels of uric acid that the body cannot excrete properly. These uric acid crystals can deposit in the synovial tissues, causing inflammation and pain.

RA is an autoimmune inflammatory condition. It occurs when the body’s immune system mistakenly attacks healthy cells in the synovial tissues or linings of the joints, resulting in inflammation, pain, and swelling. It eventually causes joint damages.

Affected areas normally include lower parts of the body especially in the joints of big toes, toes, ankles and knees.

All parts of body can be affected. It usually occurs in the fingers, hands, shoulders, toes, ankles, knees, wrists and elbows

Pain in the single spot/ pain in multiple joints are uncommon.

Pain in the multiple areas.

Pain on one side of the body (either left or right)

Pain on both sides of the body.

Swelling joints with abnormal bone formation.

Changes in the appearance and mobility of affected joints such as wrists, fingers and toes.

Pain usually attacks anytime of the day with no specific period.

Pain normally flares up after waking up in the morning, cold temperature makes it worse.

In severe cases, warm compression increases inflammation and severity.

Cold compression usually worsens the symptoms.

Pain is usually intermittent.

Pain progresses if let untreated.

f joint pain caused by either gout or rheumatoid arthritis constantly disturbs daily life and activities, medical attention must be provided as soon as possible. Accurate diagnosis and effective treatments e.g. medications, rehabilitation and surgery entirely help to prevent disease progression, resulting in a better quality of life.


Dr. Suraraj Tamronglak

Rheumatologist, Arthritis and Rheumatic Clinic. Bangkok Hospital

For more information, please contact

Arthritis and Rheumatic Clinic

5th Floor, Bangkok Hospital

Tel: +662-755-1062 or 1719 (local call)

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