Gout vs Osteoarthritis: How to Tell the Difference

Side-by-Side Comparison

Feature	Gout	Osteoarthritis
Cause	Uric acid crystal deposits	Cartilage wear and tear
Onset	Sudden (hours)	Gradual (months/years)
Pain character	Excruciating, throbbing	Aching, stiffness
Timing	Attacks come and go	Constant/progressive
Joint appearance	Red, hot, severely swollen	Mild swelling, bony bumps
Most common joint	Big toe, ankle, knee	Knee, hip, hands, spine
Triggers	Diet (red meat, alcohol, shellfish)	Activity, overuse
Blood test	Elevated uric acid	Normal uric acid
Age of onset	30-60 (men), post-menopause (women)	50+ typically
Treatment	Uric acid-lowering drugs, colchicine	PT, injections, exercise

How to Tell Them Apart

It’s Probably Gout If:

• Pain came on suddenly overnight — you went to bed fine and woke up in agony
• The joint is hot, red, and extremely swollen
• You can’t bear even the weight of a bedsheet on the joint
• The big toe is affected (classic gout presentation)
• You recently had alcohol, red meat, or shellfish
• The attack completely resolves within 1-2 weeks

It’s Probably Osteoarthritis If:

• Pain developed gradually over months
• Stiffness in the morning that improves within 30 minutes
• Pain worsens with activity and improves with rest
• You notice bony bumps or joint enlargement
• Both sides are often affected (both knees, both hands)
• Clicking or grinding sensation in the joint

Can You Have Both?

Yes. Having both gout and osteoarthritis in the same joint is common, especially in the knee. OA-damaged joints may be more susceptible to gout crystal deposits. If you have OA and experience a sudden, severe flare that’s different from your usual pain, ask your doctor to check for gout.

Treatment Differences

Gout Treatment

• During an attack: Colchicine, NSAIDs, or corticosteroids
• Prevention: Allopurinol or febuxostat (uric acid-lowering drugs)
• Diet changes: Reduce red meat, shellfish, alcohol; increase water, dairy
• Goal: Prevent attacks by keeping uric acid below 6 mg/dL

Osteoarthritis Treatment

• Conservative: Physical therapy, exercise, weight management
• Injections: Gel injections, cortisone
• Support: Bracing, assistive devices
• Goal: Manage pain, maintain function, delay surgery

Frequently Asked Questions

Can gout cause permanent joint damage?

Yes, untreated gout can cause permanent joint damage over time. This is why uric acid-lowering therapy is recommended for patients with frequent attacks.

Does diet affect osteoarthritis like it affects gout?

Diet plays a smaller role in OA than gout, but maintaining a healthy weight significantly reduces OA symptoms. An anti-inflammatory diet may provide modest benefits.

Which is more common?

Osteoarthritis is far more common — affecting over 32 million Americans. Gout affects approximately 9 million Americans.

Can gel injections help gout?

Gel injections (HA viscosupplementation) are designed for osteoarthritis, not gout. However, cortisone injections can help during a gout attack by reducing acute inflammation.

Should I see a rheumatologist or orthopedist?

If you suspect gout, see a rheumatologist — they specialize in crystal arthritis. If you suspect OA, either an orthopedist or rheumatologist can help. If you’re unsure, start with your primary care doctor.