Inquiry: I'm a 50-year-old man who has recently received a diagnosis of rheumatoid arthritis (RA). However, I've been experiencing joint symptoms for a while now, starting around two years ago with a severe episode of pain and swelling in my left toe. Since then, I've had recurring episodes of discomfort and swelling in my feet, knees, and wrists. While these incidents might indicate early signs of rheumatoid arthritis, I'm also concerned about the possibility of gout. Can you provide insight into whether I might be dealing with arthritis or gout?

Response: It appears that you may be dealing with gout, which is an inflammatory condition resulting from the deposition of sodium urate crystals in certain joints due to excess uric acid in the bloodstream. The root causes of this surplus uric acid can be genetic factors, kidney issues, certain medications (like diuretics), or excessive consumption of alcohol and purine-rich foods.

It's not uncommon for physicians to misdiagnose gout as rheumatoid arthritis (RA) when they aren't aware of your prior health concerns. In advanced stages, gout can mimic RA, leading to pain and inflammation in multiple joints. However, the underlying causes and treatments for these conditions are entirely distinct. RA occurs when the immune system mistakenly attacks the joint lining, while gout typically begins with intense pain and swelling in the big toe, often triggered by illness or injury. Subsequent attacks may affect other joints, primarily those in the foot and knee, before becoming chronic. This chronic phase, which can impact multiple joints, typically takes a few years to develop.

The good news is that gout is well-understood and treatable. Medications are available to stabilize uric acid levels and alleviate acute pain and inflammation. Proper treatment can help control gout and prevent future flare-ups. Adhering to medication regimens, even during symptom-free periods, is crucial for effective management. Maintaining a healthy weight and moderating alcohol intake can also contribute to gout control.

If you haven't already, consider discussing the possibility of analyzing a joint fluid sample for urate crystals with your healthcare provider during your next appointment. Alternatively, if the prescribed RA medication doesn't appear to be helping, scheduling an earlier visit is advisable. Promptly identifying whether you have rheumatoid arthritis or gout is essential, as early intervention can lead to quicker relief.