Double whammy: Anyone else dealing with combined PsA and gout?

Hi all,

I am dealing with both psoriatic arthritis and gout at the same time and find it to be pretty confusing when it comes to reading symptoms, diet and pain and swelling management.

My rheum said it used to be that such a diagnosis wasn't seen as possible, but apparently that's changed. I'm just curious if any of you are also dealing with this, and how you are managing.

Thanks in advance for your always helpful feedback. :)

Hi Alexis,

I have been diagnosed with gout before. Gout, put simply, refers to a build up of uric acid crystals in the joint space. When these little crystals get trapped in small spaces, the result is inflammation and intense pain.

When I was first dealing with psoriatic arthritis (in the early 80s), you heard a great deal about the association between psoriasis and gout--or at least between psoriasis and hyperuricemia (high uric acid in blood). This was thought to be due to the high turnover of skin cells present in active skin disease of psoriasis.

Recent studies seem to discount this, or to suggest that people with psorasis are no more prone to hyperuricemia than the rest of the population. My own impression about it all is that we just aren't sure yet. Research just doesn't seem to be clear.

I recently had a weak, but positive, RA test, so I asked my rheumy if I could have RA and PsA both. She, unequivocally, said, "No. You have one or the other." I wanted to ask her how your body knows this and sticks to one at a time, but you know how well received that kind of question would be!

Since gout and PsA both tend to affect joints in fingers and toes, it is not always easy to distinguish between gout and PsA without further tests. Because of this, I've never been really sure if my gout diagnosis was accurate.

To complicate things even more, there is a condition called "pseudogout" that looks clinically very much like gout. Biopsies of joint fluid are necessary to be sure if you are dealing with gout, pseudogout or PsA.

It's all pretty complicated, and I certainly understand your questions, but I'm afraid I don't have a lot of answers for you. Best of luck and hope you are having a pain-free day!


Thanks a lot for taking the time to share these helpful thoughts. On some level, knowing the confusion is natural at this stage is settling, I guess. :)

Pain-free wishes to you seems better than yesterday...learning to appreciate that a lot. :)

Hi again, Alexis,

Sounds like you are struggling, which is understandable. I believe if you asked any person on this message board if they struggle each and every day, they all would say, "Absolutely!"

One of the hardest things for me when it comes to accepting this illness is also accepting all the ambiguities. It IS tough. I've been studying it for 30+ years, and still I don't understand all I know about it! You are so right...we have to appreciate the "better" days. Hard though, at times, not to wish for more. Glad you are feeling a bit better today.

I had gout for a handful of years before I was diagnosed with PsA. I think the gout is worse when it flares up. Recently, I had gout in both big toes and it last three weeks. After trying to walk around on that for three weeks I had strained my feet, ankles, knees, and hips sot he PsA made sure it jumped on all those sore joints. I was in bad shape for about a month.

PCP finally put me on allopurinol for the gout. He had resisted previously because my liver numbers were up, but after he saw how much I was suffering he wrote me scripts. Bad thing is, you have to wait for the gout to go away before you can start the allopurinol.

One big tow joint is pretty much destroyed from the gout, I hope the other one holds up.

I can’t find good evidence that gout comes with PsA, but I know the PsA likes to join in with the gout!!

I was diagnosed with gout aged 13 and not diagnosed with PsA till I was 54. I also got skin psoriasis aged 13.