Do Psoriasis and Psoriatic Arthritis Lead to Gout?

What’s the relationship between psoriasis and gout?

Gout, psoriasis, and psoriatic arthritis (PsA) are three separate conditions. But they do share some of the same causes and some of the same symptoms.

For years, doctors have noticed a relationship between these conditions, and studies have recently supported that observation.

What are gout, psoriasis, and psoriatic arthritis?

Gout is a common form of inflammatory arthritis. It causes intense pain, swelling, and sometimes structural changes in tissues around joints, due to a buildup of uric acid crystals. It commonly affects the big toe but can affect other joints as well.

Gout affects about 4% of the U.S. population, or about 9.2 million people. It’s more common in men, older adults, and the Black community.

Psoriasis is an autoimmune condition that causes your skin cells to turn over too quickly, leading to silvery, itchy patches of skin that are sometimes ringed with redness. It happens when your immune system attacks your own body.

Psoriasis affects more than 7.55 million people in the United States, according to 2020 U.S. census data. The data shows that it’s most common in white people and occurs at roughly the same rate in men and women.

PsA is an autoimmune condition that includes the itchy, scaly skin patches of psoriasis with the stiff, sore, and inflamed joints of arthritis. PsA affects between 2% and 4% of adults.

A 2015 study found that while PsA was more common in white people, it tended to be more severe in Black people. More research is needed in this area, though.

Can psoriasis and PsA lead to gout?

Both psoriasis and PsA are related to your body’s immune response. Between 20% and 30%of people with psoriasis also have PsA.

While the two conditions are related, having one does not necessarily mean you will have the other, and the severity of psoriasis doesn’t determine whether you will develop PsA. You can also have PsA without having psoriasis.

How does that relate to gout?

Doctors have noticed for decades that there’s a connection between psoriasis, PsA, and gout, according to the Arthritis Foundation. Studies in the last few years have backed this up.

For instance, a 2015 study that examined nearly 100,000 men and women found that both conditions were positively correlated with gout. The study had its limitations, however, as it was conducted solely among healthcare professionals, 96% to 98% of whom were white.

A 2022 study also found a link between psoriasis and gout, but it was a nationwide study of only Taiwanese people. More research is needed in other populations.

The link between psoriatic disease and gout seems to be uric acid. A buildup of it in your body tissues and joints can lead to gout. A diet of foods rich in purines can cause higher uric acid buildup.

Psoriasis and PsA, which produce high levels of uric acid (called hyperuricemia) as a byproduct of high cell turnover and inflammation, may also lead to gout.

People with psoriasis also have higher levels of certain cytokines that play a role in the development of gout. Cytokines are molecules that promote inflammation and can overstimulate the activity of other immune cells, called a cytokine storm.

Other risk factors for gout

Gout was once thought to be caused mostly by a diet rich in alcohol, red meat, and other foods previously considered luxuries. Research has since shown that while diet plays a part, age, gender, and genetics may have a lot more to do with it.

Some gout risk factors are:

  • metabolic syndrome
  • family history of gout
  • untreated high blood pressure
  • obesity
  • diabetes
  • recent surgery or physical trauma
  • a diet rich in purines
  • older age
Gout in the Black community

A 2016 review of studies found that gout was more common in the Black population, mainly due to a higher prevalence of other conditions including diabetes, chronic kidney disease, obesity, and hypertension.

One study in the review indicated that many people with gout, especially Black people, were less likely to be treated by physicians in accordance with recognized standards.

Another study found that although white people were more likely to have PsA, it was more likely to be severe in Black people.

Can you prevent gout if you have psoriasis or PsA?

If you have psoriasis or PsA, doctors can help you avoid developing or worsening gout by:

  • routinely checking your serum uric acid levels
  • analyzing joint fluid to check for gout
  • recommending diet and lifestyle changes
  • prescribing urate-lowering medications

When to contact a doctor

If you have symptoms of psoriasis, PsA, or gout, it’s important to see a healthcare professional.

All three conditions can damage your joints or other organs, and they are associated with poorer health outcomes when left untreated. Arthritis that progresses can lead to joint deformity and damage, and gout can be extremely painful.

Frequently asked questions

Here are some frequently asked questions about gout and its relationship with psoriatic disease.

Can psoriasis cause gout?

Research strongly suggests an association between psoriasis and gout, but it’s not clear if psoriasis directly causes gout. More research is needed.

Can psoriatic arthritis cause gout?

Just like psoriasis, PsA is associated with gout. Experts believe this is due to PsA’s contribution to higher uric acid levels and certain inflammatory molecules. It’s not yet clear whether it directly causes gout, though.

What’s the difference between gout and psoriatic arthritis?

Though they have some common symptoms, such as joint pain, swelling, and stiffness, they also have different symptoms.

PsA symptoms include:

  • psoriasis skin symptoms
  • nail changes, such as crumbling
  • back pain, which is less common in gout
  • the swelling of several fingers and toes at once
  • eye inflammation
  • tenderness or pain in the tendons

Gout symptoms include:

  • flare-ups in between symptom-free periods
  • intense pain, redness, and swelling, especially of the big toe
  • lumps and bumps around joints, called tophi

Takeaway

Psoriasis, PsA, and gout are separate conditions with some common symptoms and a strong relationship to each other.

If you have psoriasis, you are more likely to have PsA. Both of those conditions can cause hyperuricemia, a major cause of gout, and also create cytokine changes that may play a role in gout.

If you have psoriasis or PsA, it’s important to let your healthcare team know so they can monitor your blood or joint fluid for markers indicating the development of gout.

All three conditions can have serious health effects if left untreated. If you have symptoms, it’s important to speak with a doctor.