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Gout and Behcet’s Disease: Shared Features and Differences

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Massaging foot with painful swollen gout inflammationGout and Behcet’s disease (BD) are disorders with some shared clinical, pathological, and therapeutic features. Both conditions are triggered by a strong autoinflammatory response to monosodium urate crystals. 

Both Behcet’s disease and gout involve acute inflammatory episodes that primarily affect the joints, but they can also cause systemic symptoms. The main shared clinical features are:

  • Inflammation and joint pain: Joint inflammation is one of the leading shared symptoms. In gout, this manifests as severe, sudden pain, especially in the big toe or other joints, due to the deposition of uric acid crystals. In Behcet’s disease, the main symptoms are joint swelling and pain, although they are usually not localized to one specific joint.
  • Skin problems: Both conditions can lead to skin-related symptoms. Patients with Behcet’s disease often develop tender nodules or other skin problems like oral ulcers and genital sores. Gout doesn’t typically involve skin lesions, but joint inflammation can cause pain, swelling, and redness in the affected areas, mimicking some of the symptoms seen in Behcet’s.
  • Blood vessels: Behcet’s disease causes inflammation of blood vessels throughout the body, leading to more severe outcomes such as blood clots and issues in the central nervous system. While gout isn’t primarily a vascular disease, long-term gout can cause damage to blood vessels and increase the risk of cardiovascular problems like high blood pressure and kidney disease.

In terms of shared pathological features, both Behcet’s disease and gout are characterized by excessive inflammation driven by the immune system:

  • Autoinflammatory responses: Both gout and Behcet’s disease are classified as autoinflammatory disorders, where the immune system overreacts without the presence of external pathogens. In gout, the immune system responds to uric acid crystals, triggering intense joint inflammation. In Behcet’s disease, the immune system attacks the body’s blood vessels and tissues, leading to widespread inflammation.
  • Inflammatory markers: In both conditions, patients frequently show elevated levels of inflammatory markers in the blood, such as tumor necrosis factor (TNF), which plays a significant role in driving inflammation. This shared pathway of immune activation is the main feature linking the pathology of the two diseases.
  • Therapies: Due to their shared autoinflammatory nature, both conditions can respond to similar treatments to control inflammation. Corticosteroids and anti-inflammatory medications are the first line of treatment for both gout and Behcet’s disease:
    • Corticosteroids are commonly used to treat gout flare-ups and to manage inflammation in the joints, skin, and other affected areas in Behcet’s disease.
    • Immunosuppressive drugs: Patients with more severe cases of Behcet’s disease may require immunosuppressive drugs to control the overactive immune response. Medications that reduce uric acid levels and modulate the immune system’s response to uric acid crystals are usually prescribed for long-term management of gout, especially in chronic cases.
    • TNF inhibitors: In cases where standard treatments are insufficient, both Behcet’s disease and gout disease can sometimes be treated with TNF inhibitors, which block the tumor necrosis factor responsible for driving inflammation. This treatment approach reduces systemic inflammation and prevents joint damage in both diseases.

With this basic information of the details about the shared and separate features of gout and Behcet’s disease, we list below some of the most frequent questions our pharmacy team gets from customers about these conditions, along with the best answers we are able to provide. Of course, as in any case where a person has any symptoms or concerns that promote any questions, we encourage them to consult with a doctor for the ultimate advice on the best course of action.

FAQ about Gout

A person with gout pain.What causes gout?

Gout is caused by the buildup of uric acid crystals in the joints, leading to swelling, pain, and inflammation. This buildup happens when there is too much uric acid in the blood, a condition known as hyperuricemia. Factors that can contribute to gout include consuming foods high in purines like red meat, organ meats (such as liver), and shellfish. Alcohol (especially beer) and sugary drinks also elevate uric acid levels, increasing the risk of a gout flare-up.

What autoimmune disease causes gout?

Gout itself is not considered an autoimmune disease. However, gout is an inflammatory arthritis that can co-occur with autoimmune diseases. Conditions such as Behcet’s disease or lupus, which affect the immune system, can sometimes lead to complications that involve joint pain or inflammatory arthritis similar to gout.

What is inflammatory disease gout?

Gout is a type of inflammatory arthritis caused by the deposition of uric acid crystals in the joints, leading to pain, swelling, and redness. The inflammation occurs as the immune system responds to these crystals in an effort to eliminate them, causing the joint to become painful and swollen.

What is the latest treatment for gout?

The latest treatment for gout involves a combination of medications to reduce inflammation and lower uric acid levels. Corticosteroids or other anti-inflammatory drugs like NSAIDs are used to manage pain and inflammation during gout flare-ups. Long-term treatments include drugs such as Zyloprim, which reduces uric acid production, and Uloric, which also helps control hyperuricemia.

Is gout hereditary?

Yes, gout can be hereditary. People with a family history of gout may have a higher risk of developing the condition due to genetic factors that affect how their body processes uric acid. This is referred to as inherited gout, and it can increase the likelihood of uric acid crystals forming in the joints.

Why do I get gout attacks at night?

Gout attacks at night are common because body temperature drops during sleep, causing uric acid crystals to form more easily in cooler joints. The reduced movement of joints while sleeping also contributes to the accumulation of these crystals, triggering a gout flare-up.

What foods trigger gout flare-ups?

Foods high in purines, such as red meat, organ meats (like liver), shellfish, sardines, and anchovies, can trigger gout flare-ups by increasing uric acid levels. Alcohol, particularly beer and sugary drinks, is also a common trigger, as it contributes to hyperuricemia.

What is the drug of choice for gout?

The drugs of choice for gout often include immunosuppressive drugs such as Arava (leflunomide) and Celebrex (celecoxib).  Corticosteroids can be injected by a doctor directly into the affected joint (intra-articular steroids) or given orally, such as prednisone or medrol), such as Lodotra (prednisone) or Colchine. In severe cases, tumor necrosis factor (TNF) inhibitors such as Remicade (infliximab) may be the best solution. Still, they require that they be given as an infusion at a clinic or doctor’s office, so they may not be convenient for all patients. Humira (adalimumab) is another TNF inhibitor that can be self-administered with a pre-loaded pen. They may also manage systemic inflammation and prevent complications involving the central nervous system and blood vessels.

FAQ about Behcet’s Disease

Is Behcet’s autoimmune or autoinflammatory?

Behcet’s disease is considered both autoimmune and autoinflammatory, as it involves an overreaction of the immune system that leads to inflammation in the blood vessels and other tissues. The immune system mistakenly attacks healthy tissue, causing symptoms such as oral ulcers, genital sores, and eye inflammation.

What do Behcet’s ulcers look like?

Behcet’s ulcers often resemble oral ulcers or genital sores, which can be painful and persistent. They may appear as round, shallow lesions with a red border and can be mixed up with other types of ulcers or infections.

What is the new treatment for Behcet’s disease?

The latest treatment for Behcet’s disease often includes immunosuppressive drugs and biologics, such as tumor necrosis factor (TNF) inhibitors, which help reduce inflammation. Corticosteroids or other anti-inflammatory drugs are also commonly used to manage flares and alleviate symptoms like joint pain, eye inflammation, and tender nodules on the skin.

What can be mistaken for Behcet’s?

Other conditions that cause inflammatory arthritis, mouth sores, or genital sores can be mistaken for Behcet’s disease. Conditions like lupus, Crohn’s disease, and reactive arthritis may share similar symptoms, making it essential for doctors to conduct thorough testing, such as the positive pathergy test, to diagnose Behcet’s disease properly.

How did I get Behcet’s disease?

The exact cause of the condition is unknown, but it is thought to be influenced by a combination of genetic and environmental factors. It is more common in regions such as the Middle East and may also be linked to certain immune responses triggered by infections.

FAQs about Gout and Behcet’s Disease

Is prednisone used for Behcet’s disease as well as Gout?

Yes, prednisone, a type of corticosteroid, is commonly used to treat both gout and Behcet’s disease. It helps to reduce inflammation, alleviate joint swelling, and manage gout flare-ups in patients with gout. For patients with Behcet’s disease, prednisone can control the immune response and reduce symptoms like eye inflammation and skin problems.

Do ordinary doctors treat gout and Behcet’s disease, or must I see a specialist?

For routine management, general practitioners or family doctors can treat gout. However, if the condition is severe or difficult to manage, or if the patient has frequent gout flare-ups, they may be referred to a rheumatologist. In contrast, Behcet’s disease typically requires the expertise of a rheumatologist due to its complexity and the need for specialized treatment.

What causes gout and Behcet’s disease to flare up?

Gout flare-ups are often triggered by consuming foods high in purines, such as red meat and shellfish, as well as alcohol, particularly beer and sugary drinks. Behcet’s disease flare-ups can be triggered by stress, infections, or other environmental factors that activate the immune system.

Do gout and Behcet’s disease get worse with age?

Both gout and Behcet’s disease can worsen over time if left untreated. Repeated gout flare-ups can cause long-term joint damage in gout, while the severity of symptoms can vary in Behcet’s disease. Some patients with Behcet’s experience more frequent or intense flare-ups as they age.

Are gout and Behcet’s considered a disability?

Both gout and Behcet’s disease can be considered disabilities if the symptoms are severe and limit a person’s ability to perform daily activities. For example, frequent joint swelling and pain from gout or the systemic symptoms of Behcet’s can significantly impact a person’s quality of life.

What foods should I avoid to reduce inflammation?

To reduce inflammation, it’s best to avoid foods that are high in purines, such as red meat, organ meats, and shellfish. Also, limit alcohol, especially beer, as well as sugary drinks, as these can contribute to elevated uric acid levels and worsen inflammation.

 

Picture of Henry K

Henry K

Henry has a lifelong passion for health and medical science, with hands-on experience across various areas of healthcare. He is dedicated to sharing his knowledge and insights to help others achieve optimal health.
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