Is It Psoriatic Arthritis or Gout?

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swollen feet

Like psoriatic arthritis, the inflammatory disease known as gout causes painful, swollen joints. But the two diseases have different causes—and, more important, different treatments. A doctor who specializes in arthritis, called a rheumatologist, can help you get the correct diagnosis. That way, you can start a treatment plan that will help ease your symptoms and prevent damage to your joints.

Some Symptoms Shared

It's no wonder psoriatic arthritis and gout are often confused. Besides pain and swelling in the fingers, toes, and other joints, these conditions have several other similar signs. These include:

  • Redness and heat in the affected joints

  • Flare-ups in which symptoms are worse, followed by periods of relief

People with psoriatic arthritis usually have characteristically scaly skin plaques and may also experience pitting and other changes in their fingernails. Their fingers and toes may resemble swollen sausages.

Gout, on the other hand, often strikes in the big toe first. This condition is called podraga, and it eventually affects 80 percent of people with gout. They may also develop tophi, or lumps under the skin that cluster on their elbows, ears, or other parts of the body.

5 Tips For People With Psoriatic Arthritis From People With Psoriatic Arthritis

Different Pathways to Joint Pain

Psoriatic arthritis occurs when an overactive immune system targets the joints. Some evidence suggests an infection or genetics may play a role in its development. The condition usually occurs in people ages 30 to 50, most of whom have developed psoriasis on the skin first.

Gout, however, is a metabolic abnormality. Gout results from the buildup of a compound called uric acid in the blood. Eventually, crystals of uric acid form in the joints, triggering pain and swelling. Being overweight and having high blood pressure put you at risk for this condition. So, too, does drinking alcohol and eating meats and seafood, because uric acid forms when your body digests these foods.

Tests Can Help Tell Them Apart

There's no one test to identify psoriatic arthritis. Your doctor will ask you about your symptoms, examine your joints, and do blood and other tests that rule out gout and similar diseases.

High blood levels of uric acid, often used to detect gout, may not rule out psoriatic arthritis. If you take low doses of aspirin or have psoriasis, your blood may contain extra uric acid even if you don't have gout. Instead, your doctor may draw fluid from your joint and test it for urate crystals. If they're present, you likely have gout.

It is possible to have both psoriatic arthritis and gout. If you've already been diagnosed with psoriatic arthritis but have sudden, severe pain in one joint—especially the big toe—talk with your doctor about being tested for gout.

If your disease has progressed, X-rays may help your doctor identify the cause of your pain. For people with psoriatic arthritis, but not other types of arthritis, the ends of the bones may wear down to a sharp point. This is called the "pencil in cup" phenomenon. Pain in your spine also points to psoriatic arthritis instead of gout or another condition.

Treatment Eases Pain

As with most types of arthritis, there's no cure for either gout or psoriatic arthritis. But medications and other therapies can relieve pain, reduce symptoms, and delay recurrences. Ibuprofen, naproxen, and other over-the-counter pain relievers are often used for people with psoriatic arthritis. If the condition doesn't respond, your doctor may recommend prescription drugs. Surgery can help repair or replace damaged joints.

Key Takeaways

  • Psoriatic arthritis and gout are often confused because they share some similar symptoms, including pain and swelling in the fingers and toes.

  • Psoriatic arthritis occurs when an overactive immune system targets the joints. Gout results from the buildup of a compound called uric acid in the blood.

  • Certain tests can help tell these diseases apart, leading to better treatment and pain relief.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Mar 1
  1. Psoriatic Arthritis Diagnosis. Arthritis Foundation. http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/diagnosing.php
  2. Gout. Centers for Disease Control and Prevention. http://www.cdc.gov/arthritis/basics/gout.html
  3. Living With Arthritis: Health Information Basics for You and Your Family. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Arthritis/default.asp
  4. Questions and Answers About Gout. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Disease. http://www.niams.nih.gov/Health_Info/Gout/default.asp    
  5. Tests to Confirm the Diagnosis. National Psoriasis Foundation. https://www.psoriasis.org/psoriatic-arthritis/diagnosis/tests-to-confirm
  6. Diagnosing Psoriatic Arthritis. National Psoriasis Foundation. https://www.psoriasis.org/psoriatic-arthritis/diagnosis
  7. Psoriatic Arthritis. National Psoriasis Foundation. https://www.psoriasis.org/sites/default/files/staff/welcome/doc912.pdf
  8. Rheumatology is a specialty. National Psoriasis Foundation. https://www.psoriasis.org/psoriatic-arthritis/find-the-right-doctor/rheumatology
  9. Psoriatic Arthritis. American College of Rheumatology. http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis
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