A woman laying in bed, holding her head and a thermometer.
While both gout and septic arthritis cause red and tender joints, septic arthritis can also cause fatigue and chills, and people may experience a fever with gout.

Gout vs. Septic Arthritis

Gout is a common type of inflammatory arthritis that often affects the big toe. It is a very painful condition that tends to come and go, with symptoms flaring up at times and then going into remission. Repeated episodes of gout can lead to a condition known as gouty arthritis, which is a more severe form of arthritis. While there is no cure for gout, it can be effectively managed with home treatment and medication. However, septic arthritis can present similarly to gout. So, when it comes to gout vs. septic arthritis, how can you tell them apart? Find out here.

What is Septic Arthritis?

Septic arthritis, also known as infectious arthritis, is infection in the synovial fluid of the joint and joint tissues that is usually caused by bacteria, but can also be caused by fungus or viruses.

Symptoms of Gout

Symptoms of a gout flare-up typically start suddenly and persist for days to weeks, followed by a long period of remission. Gout usually only affects one joint at a time, with the big toe being commonly affected. Other joints that may be affected are the other toe joints, ankle and/or knee. Symptoms may include the following:

  • Joint pain that is usually severe.
  • Joint swelling.
  • Joint redness.
  • Joint warmth.
  • Fever.

Symptoms of Septic Arthritis

Symptoms of septic arthritis usually start suddenly with severe pain, joint swelling and fever. Septic arthritis often only affects one joint, most commonly the knee, hip, elbow, shoulder, wrist and finger. Additional symptoms may include:

  • Chills.
  • Fatigue.
  • Inability to move the affected joint.
  • Joint redness.
  • Joint warmth.

Causes of Gout

Gout is caused by having too much uric acid in the body, known as hyperuricemia. When you eat food, your body breaks down purines and makes uric acid. Too much uric acid can lead to the build-up of uric acid crystals in the joints, fluids and tissues in the body.

Causes of Septic Arthritis

Bacteria, viruses and fungi can lead to a septic arthritis. The most common pathogen that causes septic arthritis in children and adults is Staphylococcus aureus. The most common pathogen that causes septic arthritis in young, sexually active adults is Neisseria gonorrhea. These pathogens enter the bloodstream and infect the joint, leading to pain and inflammation.

Pathogens can enter in the body in various ways including:

  • A broken bone that punctures the skin (open fracture).
  • Wound infection.
  • Surgical procedure.
  • An infection that travels from another area in the body (i.e., skin).
  • Foreign object or injury that breaks the skin.

Other bacteria, viruses and fungi that can lead to septic arthritis include:

  • Haemophilus influenzae.
  • Gram negative bacilli.
  • Streptococci.
  • Hepatitis A, B and C.
  • Parvovirus B19.
  • HIV.
  • Coxsackie viruses.
  • Adenovirus.
  • Mumps.
  • HTLV-1.
  • Alphaviruses.
  • Flaviviruses.
  • Histoplasma.
  • Coccidiomycosis.
  • Blastomyces.
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Treatment for Gout

Treating gout includes both self-management techniques and medical treatment, including:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) to manage joint pain and inflammation during a flare-up.
  • Making lifestyle changes to prevent future flare-ups – maintaining a healthy weight, reducing alcohol intake, eating less purine-rich foods, such as red meat, and changing medications that are linked to hyperuricemia.
  • Medications to lower uric acid levels (allopurinol, pegloticase, febuxostat) to prevent kidney stones and tophi.

Treatment for Septic Arthritis

Treatment for septic arthritis depends on your age, symptoms, severity of the disease and your overall health. Often, septic arthritis is caused by bacteria and needs to be treated immediately with antibiotics. Infections caused by fungi require anti-fungal medications, and viral infections are not treated with specific medication.

In order to clear the infection, drainage of the infected area is often necessary. Drainage is performed with a needle and syringe and may occur several times over the course of treatment. If drainage cannot be completed with minor procedures, open-joint surgery may be necessary. If fluid build-up is serious, drains may be left in place after the surgery to allow proper drainage after surgery.

Additional treatment options for septic arthritis include:

  • Medications to control fever and pain.
  • Physical therapy to maintain joint function and muscle strength.
  • Splinting of the joint to relieve pain.

Gout vs. Septic Arthritis: The Similarities

Gout and septic arthritis both have acute swelling, pain and warmth and redness of a joint that increases over several hours. Additionally, fever is common with both gout and septic arthritis.

Gout vs. Septic Arthritis: The Differences

Septic arthritis commonly affects the knee, with infection of the knee occurring in about 50% of cases, whereas gout commonly affects the big toe. Additionally, individuals with septic arthritis often have systemic symptoms of sepsis, including both fever and fatigue, in addition to joint symptoms.

Lab analysis of fluid taken from the affected joint will reveal the pathogen causing the infection in those with septic arthritis.

How Can You Decipher if You Have Gout or Septic Arthritis?

Differentiating gout from septic arthritis can be difficult because they often present with similar signs and symptoms. If you have recently had joint surgery, you should suspect septic arthritis if you have symptoms of joint pain, swelling, tenderness and fever. Additionally, septic arthritis should be suspected until proven otherwise if you are over 80 years of age, have rheumatoid arthritis, diabetes, are immunocompromised or are an IV drug user. In any case, if you have symptoms of joint pain, swelling, tenderness, warmth and fever, it is important to seek medical attention as prompt diagnosis and treatment of septic arthritis are necessary to prevent joint damage and further complications.