Understanding the Relationship Between Gout and Autoimmune Diseases
Medically reviewed by Anita C. Chandrasekaran, MD
Gout is a painful inflammatory condition. Symptoms of gout often mimic those of autoimmune diseases such as rheumatoid arthritis (RA). When symptoms hit, you may wonder what causes it and if you have an autoimmune disease.
This article discusses the causes of gout, its relationship to autoimmune diseases, and what you can do about it.
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Is Gout an Autoimmune Disease?
Gout is due to excess uric acid in the body. Uric acid crystals form in the joints and tissues, and the body reacts to these with inflammation. Gout is an auto-inflammatory disease, but not an autoimmune disease.
Similar to many autoimmune diseases, gout tends to have periods of active inflammation followed by periods of remission. But in autoimmune diseases, the immune system mistakenly attacks healthy tissue.
Understanding Gout
Gout is the most common type of inflammatory arthritis. It affects about 9.2 million people in the United States.
Gout causes acute inflammation in one or more joints, known as a gout flare-up. It often presents with sudden, intense pain and swelling. These attacks occur as crystallized uric acid builds up in the joint.
Gout is most likely to occur in the big toe. That's because uric acid is temperature-sensitive, and the toe, being far from the heart, is cooler than the rest of the body. But it can occur in any joint, such as the wrist or ankle.
Untreated gout can cause permanent joint damage, known as chronic gouty arthritis. In addition, crystals of uric acid can leave hard lumps called tophi in the skin.
What Causes Gout?
Gout occurs due to hyperuricemia (excess uric acid in the blood) and the depositing of uric acid crystals, which leads to acute inflammation in one or more joints.
Your body makes uric acid as it breaks down chemicals called purines. You can develop gout if your kidneys can't properly get rid of uric acid or if your body produces too much uric acid.
Hyperuricemia can also happen when you eat a lot of high-purine foods such as meats, certain types of seafood, and alcohol. Other factors that can lead to higher uric acid levels are:
Inadequate hydration
Overweight and obesity
Insulin resistance (cells in the body don't respond well to insulin and can't take up sugar, or glucose, from the blood, causing the pancreas to produce more insulin)
Elevated uric acid alone isn't always enough to cause gout, though.
In one study, only 9% of people with hyperuricemia of 7.0 to 8.9 milligrams per deciliter (mg/dL) had a gout flare-up over 15 years. And at levels above 10 mg/dL, only half had gout over 15 years. Researchers have identified at least 13 inflammatory pathway genes that may be involved in the development of gout.
Gout Symptoms
Symptoms of gout include:
Intense pain in the affected joint, usually a big toe
Pain that starts suddenly at night, waking you from sleep
Joint that looks swollen, red, and warm
Gout can also affect:
Bursae, the cushiony sacs between bones and other soft tissues
Tendon sheaths, the membranes around the tendons
Kidneys, which can develop stones due to high levels of uric acid
Some things that may trigger a flare-up are:
Excess high-purine foods
Alcohol
Very cold or very warm weather
Dehydration
Joint injury
Excess physical activity
Certain medications or illnesses
A flare-up might last a week or two, followed by a period of remission. Some people experience flare-ups frequently, while others go years between symptoms. Untreated, flares may worsen over time, happening more often, lasting longer, and involving more joints.
Risk Factors for Gout
Gout affects about 1% to 4% of the general population. Factors that may increase the risk of developing gout include:
Family history of gout
Being male
Menopause (time of life when menstrual periods have stopped for 12 months in a row)
Increasing age
Drinking alcohol
Unhealthy diet and foods rich in purines
Overweight or obesity
Metabolic syndrome (a combination of symptoms that increase the risk of heart disease, type 2 diabetes, and stroke)
Chronic kidney disease
Hypertension
Psoriasis
Some types of cancer
Rare genetic conditions such as Kelley-Seegmiller syndrome and Lesch-Nyhan syndrome
Medications such as diuretics (rid the body of excess fluids), low-dose aspirin, niacin, and cyclosporine
A Note on Gender and Sex Terminology
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as they are used in the sources.
What Is an Autoimmune Disease?
The immune system attacks foreign organisms and substances to guard against disease and infection. When you have an autoimmune disease, the immune system mistakenly attacks healthy cells. There are more than 80 types of autoimmune diseases, including type 1 diabetes and rheumatoid arthritis. Having one increases the risk of developing another.
As with gout, people with autoimmune disorders may experience flare-ups of disease activity. It's not clear exactly what causes someone to develop an autoimmune disease. Treatment may involve anti-inflammatory drugs and/or immunosuppressants.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is a progressive autoimmune disease characterized by joint inflammation. It usually attacks many joints at the same time, commonly affecting the hands, wrists, and knees.
It's classically a symmetrical disease, affecting the same joints on both sides of the body. Without treatment, RA can lead to permanent joint damage. It can also affect the lungs, eyes, and skin.
RA and gout share similar symptoms, and it's possible to have both. In a study of almost 2,000 people with RA, 17% had high levels of uric acid, and 6.1% also had gout.
Lupus
Systemic lupus erythematosus is a chronic autoimmune disease that can affect many parts of the body and may cause arthritis-like symptoms. In addition to the joints, lupus can affect the skin, heart, lungs, kidneys, brain, and blood vessels.
Celiac Disease
In someone with celiac disease, eating gluten triggers an inflammatory response that damages the lining of the intestines. Gluten is a protein found in wheat, barley, and rye grains. Researchers believe it may develop due to a combination of many different genetic and nongenetic factors.
Some people with celiac disease develop joint pain symptoms.
Crohn's Disease
Crohn's disease is an inflammatory bowel disease that mainly affects the digestive system. It is considered immune-mediated. Some people develop joint problems related to Crohn's disease, including joint pain and swelling in the back, hands, feet, arms, and legs.
Addison's Disease
Addison's disease is a rare disorder that happens when the immune system attacks the adrenal glands, which disrupts production of vital hormones. Common symptoms include fatigue, skin discoloration, gastrointestinal problems, and muscle and joint pain. Addison's disease can lead to adrenal failure, a life-threatening condition.
Graves' Disease
Graves' disease happens when the immune system attacks the thyroid, which then produces more hormones than you need. Untreated, Graves' disease can lead to serious problems such as osteoporosis, heart failure, and stroke.
You may be at higher risk of developing Graves' disease if you have vitiligo (a condition causing loss of pigment in patches of skin), type 1 diabetes, RA, or autoimmune gastritis.
How Can You Manage Gout?
If you have hyperuricemia but no symptoms of gout, you don't need treatment. Gout is very manageable. With treatment and lifestyle changes, many people can avoid flare-ups and have milder symptoms. Some can become gout-free. Without treatment, you may have more frequent and severe flare-ups.
Gout symptoms usually resolve in three to 10 days with treatment. When you have a gout flare-up, it can help to rest your foot. Try not to walk or stand too much and elevate it when possible. You can also apply ice or a cold compress to ease the pain.
Treatment for a gout flare-up may include anti-inflammatory medications such as Colcrys (colchicine), nonsteroidal anti-inflammatory drugs (NSAIDs), or oral steroids.
Longer-term medications, such as Zyloprim (allopurinol), Uloric (febuxostat), and Probalan (probenecid), may help lower uric acid levels and the risk of future flares.
Changes to your diet can also help reduce future attacks. These include:
If you drink alcohol, cut down (including nonalcoholic beer that may contain purines)
Avoid sugary drinks
Avoid foods that are high in purines, including red meats, organ meats, shellfish, sardines, and anchovies
Follow the DASH (Dietary Approaches to Stop Hypertension( diet, which includes plenty of vegetables, fruits, and whole grains
Other ways to prevent future gout flare-ups include:
Stay well hydrated.
Get regular exercise.
Try to lose weight if you are carrying excess weight or have obesity.
Speak to a healthcare provider about avoiding medications, such as diuretics, that are associated with gout.
Keep medical appointments and manage coexisting conditions.
Summary
Gout is a painful form of arthritis. It usually flares up in one joint at a time, usually the big toe. Gout has a lot in common with certain autoimmune diseases. But autoimmune diseases develop due to a faulty immune system response. Gout develops because you have too much uric acid in your body.
The good news is that gout is manageable in most cases. With treatment, a typical flare-up resolves in three to 10 days. And a few lifestyle changes, especially avoiding certain foods, can help prevent future attacks.
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