Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prevention
Psoriatic arthritis(PsA) andgoutare types ofinflammatory arthritisthat cause pain and swelling of the fingers, toes, knees, ankles, and other joints. While they have some similar symptoms and causes, they are very different conditions and are managed and treated differently.
This article will discuss the different symptoms of PsA vs. gout, what causes these conditions, how they are diagnosed and treated, and why PsA might increase your risk for gout.
Verywell / Jessica Olah
The symptoms of PsA and gout can sometimes overlap, so it is important to understand the symptoms specific to each condition.
Psoriatic ArthritisPain and stiffness in multiple jointsAffected joints on one or both sides of the bodyLarge joint involvement: Especially the lower extremitiesNail involvement: Nail pitting, crumbling, and ridging, and nailbed separationPsoriasis skin symptomsSpine involvement: Stiffness and pain in the back or neck, and difficulty with bendingEnthesitis (inlfammation of connective tissue at joints), especially of the back of the heels and the soles of the feetDactylitis (extreme swelling of fingers and toes)Eye inflammationGoutIntermittent episodes of sudden red, hot, swollen jointsPain in the big toe, with warmth and rednessPain and swelling of other jointsPolyarticular symptoms (gout attack in more than three joints)Tophi (lumps in and around the joints)Spine or sacroiliac (connecting pelvis to lower spine) joint involvement is rareLingering discomfortWarmth and redness of affected jointsLimited range of motion
Psoriatic ArthritisPain and stiffness in multiple jointsAffected joints on one or both sides of the bodyLarge joint involvement: Especially the lower extremitiesNail involvement: Nail pitting, crumbling, and ridging, and nailbed separationPsoriasis skin symptomsSpine involvement: Stiffness and pain in the back or neck, and difficulty with bendingEnthesitis (inlfammation of connective tissue at joints), especially of the back of the heels and the soles of the feetDactylitis (extreme swelling of fingers and toes)Eye inflammation
Pain and stiffness in multiple joints
Affected joints on one or both sides of the body
Large joint involvement: Especially the lower extremities
Nail involvement: Nail pitting, crumbling, and ridging, and nailbed separation
Psoriasis skin symptoms
Spine involvement: Stiffness and pain in the back or neck, and difficulty with bending
Enthesitis (inlfammation of connective tissue at joints), especially of the back of the heels and the soles of the feet
Dactylitis (extreme swelling of fingers and toes)
Eye inflammation
GoutIntermittent episodes of sudden red, hot, swollen jointsPain in the big toe, with warmth and rednessPain and swelling of other jointsPolyarticular symptoms (gout attack in more than three joints)Tophi (lumps in and around the joints)Spine or sacroiliac (connecting pelvis to lower spine) joint involvement is rareLingering discomfortWarmth and redness of affected jointsLimited range of motion
Intermittent episodes of sudden red, hot, swollen joints
Pain in the big toe, with warmth and redness
Pain and swelling of other joints
Polyarticular symptoms (gout attack in more than three joints)
Tophi (lumps in and around the joints)
Spine or sacroiliac (connecting pelvis to lower spine) joint involvement is rare
Lingering discomfort
Warmth and redness of affected joints
Limited range of motion
Psoriatic Arthritis
PsA affects less than 1% of the American population.While this percentage might seem small, people with the inflammatory skin conditionpsoriasisaccount for many of the PsA cases. Psoriasis causes an overproduction of skin cells that pile up on the skin as plaques, red patches covered in silvery scales.
According to the National Psoriasis Foundation, nearly one-third of people with psoriasis will develop PsA.If you have psoriasis and develop joint pain, reach out to your healthcare provider to be assessed for PsA.
The most common symptoms of PsA are:
Gout
Symptoms of gout include:
PsA–Gout Connection
People withpsoriatic disease(PsA and/or psoriasis) have an increased risk of developing gout. This connection has been known for decades. Researchers think this is because of uric acid, which forms when the body breaks down purines found in human cells and many foods.
In people with PsA and psoriasis, uric acid might be to blame for skin cell overproduction and systemic inflammation. In people with gout, that uric acid builds up in and around joints.
A study reported in 2014 in the journalDrug Development Researchfound uric acid blood levels in 20% of the 338 study participants with psoriasis.Here, researchers also found that psoriasis was the stronger predictor of hyperuricemia (high uric acid levels).
A large study published in 2015 aimed to determine whether people with psoriasis and PsA have a higher risk of gout than people without these conditions.This study included 98,810 people with psoriasis and/or PsA living in the United States who were followed over many years.
Here, researchers found the risk for gout was almost twice as high for people with psoriasis. People with both psoriasis and PsA had a risk 5 times higher.
The researchers noted while it was previously suspected that a link between psoriatic disease and gout occurred, this was the first time that risk was assessed in a large group of people with psoriatic disease.
These findings highlight the importance of doctors looking out for psoriatic disease complications and thinking about gout as a possible cause of inflamed joints even in the presence of psoriatic disease.
How to Stop Gout Pain at Night and Sleep Better
PsA is an autoimmune disease that results when the immune system malfunctions and targets healthy tissues, usually the joints and sometimes the skin.
On the other hand, gout is considered a metabolic disorder that causes the accumulation of uric acid in the blood and tissues. That buildup eventually triggers joint pain and swelling.
Researchers don’t know exactly what causes psoriatic arthritis. What they do know is that the immune system is involved in the development of both PsA and psoriasis.
Researchers believe gene changes may influence the development of PsA. The most studied genes linked to PsA are part of a family of genes called thehuman leukocyte antigen(HLA) complex.
HLA helps the immune system to distinguish the body’s proteins from those related to foreign invaders like viruses and bacteria. Variations in HLA genes seem to be connected to the development of PsA, as well as severity, type of PsA, and disease progression.
Family history also plays a role in PsA, and psoriatic disease tends to run in families. An inheritance pattern for PsA is unknown, but around 40% of people who get PsA have at least one close family member with psoriasis or PsA.
Environmental factors might also lead to the development of PsA. Injuries, infections, chronic stress, and exposure to toxins can also trigger PsA, especially in people with a family history of the condition.
Risk factors for PsA are:
There was a time when gout was called a “rich man’s disease” or the “disease of the kings.” It was thought to affect only wealthy men who consumed decadent food and drinks. Researchers know now that gout has to do with how much uric acid is in the blood as a result of diet choices, rather than the amount of money a person has.
Gout is also related to genetics. Studies have identified dozens of genes that play a role in triggering the condition.Of all the genes studied, two genes—SLC2A9 and ABCG2—seem to have the greatest influence on uric acid levels.
SLC2A9 generally provides instructions for making a protein found in the kidneys that manages the body’s levels of urate (the salt derived from the uric acid).Changes in this gene increase the reabsorption rate of urate into the bloodstream and decrease urate levels that exit the body through urine.
ABCG2 provides instruction for making a protein that helps to release urate from the body.Genetic changes to ABCG2 lead to elevated uric acid levels in the blood, which reduces the protein’s ability to release urate into the gut.
Nongenetic changes can also play a role in the development of gout and in triggering gout attacks. These changes increase the urate levels in the body, including the consumption of certain foods and beverages that contain high amounts of purines.Purines are found in seafood, red meat, alcohol, and sugary beverages.
Risk factors for gout include:
There is no single test to identify PsA. High blood levels of uric acid might help detect gout, but that same blood work cannot rule out PsA. This is because people with psoriasis and PsA may have high uric acid levels and not have gout.
For both conditions, doctors will employ different testing methods to diagnose PsA or gout, including discussing symptoms and family history, examining joints, blood work, and other tests to rule out other conditions and similar diseases.
A diagnosis of gout is usually based on symptoms and the appearance of affected joints. Your doctor may also request tests to help diagnose gout and rule out other conditions:
As with most types of inflammatory arthritis, there is no cure for PsA or gout. But treatments for both conditions can relieve pain, reduce symptoms, and prevent failure.
Treatment for PsA will depend on how severe the condition, type of PsA, and if you already have joint symptoms.
One of the first treatments for PsA isnonsteroidal anti-inflammatory drugs(NSAIDs), such as Advil or Motrin (ibuprofen) and Aleve (naproxen), which are recommended for people with mild disease who have not yet experienced joint damage.
Conventionaldisease-modifying antirheumatic drugs(DMARDs), such as Trexall (methotrexate), are second-line therapies for people whose disease is active and who experience pain, swelling, and skin symptoms more frequently. These drugs work on the immune system to prevent damage to the joints, spine, and tendons.
Additional treatment options for PsA can also help to manage your symptoms. These might include:
Medications to help reduce symptoms of gout include:
Drugs that can help lower uric acid levels in your body to prevent or reduce future gout attacks include:
Inflammatory arthritis conditions like PsA and gout are rarely preventable. While researchers know that some people have a higher risk for these conditions, there are no treatments or preventive measures that guarantee you won’t get PsA or gout.
Some people experience both PsA and gout. So, it is important to look for signs of gout if you have been diagnosed with PsA.
PsA flare-ups and gout attacks might be preventable and symptoms of both these conditions are manageable. Managing stress and diet, being active, and following your treatment plan are the best ways to prevent symptom flare-ups in both conditions.
Summary
Psoriatic arthritis and gout are two types of inflammatory arthritis that are sometimes confused because they share symptoms, including pain and swelling of the fingers and toes.
PsA occurs when the immune system malfunctions and targets the joints. Gout is the result of the buildup of uric acid in the blood.
Certain tests can help to tell PsA and gout apart including blood work and joint aspiration testing. These conditions are not always preventable, but they are manageable and treatable.
A Word From Verywell
If you experience joint pain or stiffness, seeing a rheumatologist can help you get an accurate diagnosis. A rheumatologist is a doctor who specializes in arthritis, other musculoskeletal conditions, and systemic autoimmune diseases.
While types of arthritis share symptoms, they are different diagnoses and can affect you in different ways. And while treatments can overlap, every type of arthritis should be evaluated and treated separately.
If you are diagnosed with PsA or gout, it is important to keep these conditions managed to protect your joints. Early and aggressive treatment can reduce joint damage and improve your quality of life.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001National Psoriasis Foundation.Psoriasis statistics. Updated October 8, 2020.Johns Hopkins Arthritis Center.Symptoms and diagnosis of goutAvhad G, Ghuge P.Podagra.Indian Dermatol Online J. 2014;5(Suppl 2):S134-S135. doi:10.4103/2229-5178.146196Fargetti S, Goldenstein-Schainberg C, Silva Abreu A, Fuller R.Refractory gout attack.Case Rep Med. 2012;2012:657694. doi:10.1155/2012/657694Cardoso FN, Omoumi P, Wieers G, et al.Spinal and sacroiliac gouty arthritis: report of a case and review of the literature.Acta Radiol Short Rep. 2014;3(8):2047981614549269. doi:10.1177/2047981614549269Gisondi P, Targher G, Cagalli A, Girolomoni G.Hyperuricemia in patients with chronic plaque psoriasis.J Am Acad Dermatol. 2014 Jan;70(1):127-30. doi:10.1016/j.jaad.2013.09.005Merola JF, Wu S, Han J, Choi HK, Qureshi AA.Psoriasis, psoriatic arthritis and risk of gout in US men and women.Ann Rheum Dis. 2015;74(8):1495-1500. doi:10.1136/annrheumdis-2014-205212MedlinePlus.Psoriatic arthritis. Updated August 18, 2020.Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1Cleveland Clinic.Psoriatic arthritis. Updated November 29, 2019.MedlinePlus.Gout. Updated September 29, 2020.Cleveland Clinic.Gout. Updated November 15, 2020.Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?.Rheumatol Ther.2019;6(3):305-315. doi:10.1007/s40744-019-0159-1
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001National Psoriasis Foundation.Psoriasis statistics. Updated October 8, 2020.Johns Hopkins Arthritis Center.Symptoms and diagnosis of goutAvhad G, Ghuge P.Podagra.Indian Dermatol Online J. 2014;5(Suppl 2):S134-S135. doi:10.4103/2229-5178.146196Fargetti S, Goldenstein-Schainberg C, Silva Abreu A, Fuller R.Refractory gout attack.Case Rep Med. 2012;2012:657694. doi:10.1155/2012/657694Cardoso FN, Omoumi P, Wieers G, et al.Spinal and sacroiliac gouty arthritis: report of a case and review of the literature.Acta Radiol Short Rep. 2014;3(8):2047981614549269. doi:10.1177/2047981614549269Gisondi P, Targher G, Cagalli A, Girolomoni G.Hyperuricemia in patients with chronic plaque psoriasis.J Am Acad Dermatol. 2014 Jan;70(1):127-30. doi:10.1016/j.jaad.2013.09.005Merola JF, Wu S, Han J, Choi HK, Qureshi AA.Psoriasis, psoriatic arthritis and risk of gout in US men and women.Ann Rheum Dis. 2015;74(8):1495-1500. doi:10.1136/annrheumdis-2014-205212MedlinePlus.Psoriatic arthritis. Updated August 18, 2020.Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1Cleveland Clinic.Psoriatic arthritis. Updated November 29, 2019.MedlinePlus.Gout. Updated September 29, 2020.Cleveland Clinic.Gout. Updated November 15, 2020.Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?.Rheumatol Ther.2019;6(3):305-315. doi:10.1007/s40744-019-0159-1
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001National Psoriasis Foundation.Psoriasis statistics. Updated October 8, 2020.Johns Hopkins Arthritis Center.Symptoms and diagnosis of goutAvhad G, Ghuge P.Podagra.Indian Dermatol Online J. 2014;5(Suppl 2):S134-S135. doi:10.4103/2229-5178.146196Fargetti S, Goldenstein-Schainberg C, Silva Abreu A, Fuller R.Refractory gout attack.Case Rep Med. 2012;2012:657694. doi:10.1155/2012/657694Cardoso FN, Omoumi P, Wieers G, et al.Spinal and sacroiliac gouty arthritis: report of a case and review of the literature.Acta Radiol Short Rep. 2014;3(8):2047981614549269. doi:10.1177/2047981614549269Gisondi P, Targher G, Cagalli A, Girolomoni G.Hyperuricemia in patients with chronic plaque psoriasis.J Am Acad Dermatol. 2014 Jan;70(1):127-30. doi:10.1016/j.jaad.2013.09.005Merola JF, Wu S, Han J, Choi HK, Qureshi AA.Psoriasis, psoriatic arthritis and risk of gout in US men and women.Ann Rheum Dis. 2015;74(8):1495-1500. doi:10.1136/annrheumdis-2014-205212MedlinePlus.Psoriatic arthritis. Updated August 18, 2020.Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1Cleveland Clinic.Psoriatic arthritis. Updated November 29, 2019.MedlinePlus.Gout. Updated September 29, 2020.Cleveland Clinic.Gout. Updated November 15, 2020.Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?.Rheumatol Ther.2019;6(3):305-315. doi:10.1007/s40744-019-0159-1
Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001
National Psoriasis Foundation.Psoriasis statistics. Updated October 8, 2020.
Johns Hopkins Arthritis Center.Symptoms and diagnosis of gout
Avhad G, Ghuge P.Podagra.Indian Dermatol Online J. 2014;5(Suppl 2):S134-S135. doi:10.4103/2229-5178.146196
Fargetti S, Goldenstein-Schainberg C, Silva Abreu A, Fuller R.Refractory gout attack.Case Rep Med. 2012;2012:657694. doi:10.1155/2012/657694
Cardoso FN, Omoumi P, Wieers G, et al.Spinal and sacroiliac gouty arthritis: report of a case and review of the literature.Acta Radiol Short Rep. 2014;3(8):2047981614549269. doi:10.1177/2047981614549269
Gisondi P, Targher G, Cagalli A, Girolomoni G.Hyperuricemia in patients with chronic plaque psoriasis.J Am Acad Dermatol. 2014 Jan;70(1):127-30. doi:10.1016/j.jaad.2013.09.005
Merola JF, Wu S, Han J, Choi HK, Qureshi AA.Psoriasis, psoriatic arthritis and risk of gout in US men and women.Ann Rheum Dis. 2015;74(8):1495-1500. doi:10.1136/annrheumdis-2014-205212
MedlinePlus.Psoriatic arthritis. Updated August 18, 2020.
Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1
Cleveland Clinic.Psoriatic arthritis. Updated November 29, 2019.
MedlinePlus.Gout. Updated September 29, 2020.
Cleveland Clinic.Gout. Updated November 15, 2020.
Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?.Rheumatol Ther.2019;6(3):305-315. doi:10.1007/s40744-019-0159-1
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