Is There a Connection Between Multiple Sclerosis (MS) and Gout?

Gout and multiple sclerosis (MS) might seem like very different conditions, but there is a connection between the two. Research has found that people with MS may be less susceptible to gout. Additionally, high levels of uric acid (found in gout) have been associated with protection against MS and other neurological diseases.

Scientists are still trying to determine the connection between MS and gout, and some of the research is conflicting. This article reviews what is known about the two conditions and their link.

The Science Behind MS and Gout

Both MS and gout seem to be influenced by uric acid, which is found in high levels in people with gout but low levels in people with MS.

Uric acid is a waste product present in the blood, kidneys, and urine. It is produced when the body breaks down purines, a chemical found in certain foods like red meat, seafood, beer, and organ meats.

Older research on MS and uric acid has found that:

• People with MS have lower serum uric acid levels than the general public.
• People with gout have a lower risk of developing MS.
• Low uric acid levels correlate with MS disease progression and relapse.

It is theorized that uric acid and, by consequence, gout could have a protective quality over MS and other neurological diseases.

A 2015 study examined 9 million hospital records to identify people with gout, MS, Parkinson's disease, or motor neuron diseases. The study found that, unlike previously thought, people with gout were not less likely to develop MS but that people with MS were less likely to have gout. The researchers concluded that existing MS may reduce the incidence of a person having gout.

While the link between uric acid and MS is undeniable, it is unclear whether having low uric acid levels is a cause or consequence of MS.

Uric Acid as an Antioxidant for Neurons 

Uric acid has antioxidant properties, which means it can prevent cell damage. Oxidative damage can contribute to the neuron damage found in MS and other neurological diseases. As a result, it has been proposed that uric acid may be protective against neurological diseases, like MS, due to its antioxidant effects on neurons. However, this has not yet been proven.

Uric acid is also believed to be a chemical that alerts the immune system to cell damage. In this way, it might act as a "danger signal" to neurological damage.

Multiple Sclerosis vs. Gout 

Gout is a type of arthritis in which uric acid crystals collect in certain joints, causing intense pain and swelling. MS is an autoimmune disease in which the protective myelin sheath around nerves in the central nervous system is destroyed. This causes weakness, pain, cognitive issues, and other symptoms.

The two conditions are very different, and often mutually exclusive. However, they seem to be linked by uric acid.

Symptoms

Multiple Sclerosis

MS is an autoimmune, neurological disease. Symptoms of MS differ from person to person, and depend on what type of MS the person has.

Symptoms can include:

• Fatigue
• Vision issues
• Vertigo
• Muscle weakness
• Spasticity (increased muscle tone or stiffness)
• Cognitive issues
• Pain
• Sensory issues
• Bowel and bladder dysfunction
• Depression
• Sexual dysfunction

Gout

Gout is a type of arthritis known for its intense, sudden joint pain, often starting in the big toe. Symptoms of gout can include:

• Sudden and severe joint pain
• Joint stiffness
• Joint swelling
• Tophi (crystal deposits in soft tissue, joints, and cartilage)

Causes 

Multiple Sclerosis

MS is an autoimmune disease, which means it's a result of the immune system attacking healthy parts of the body. In the case of MS, it attacks the protective myelin sheath around nerves.

Why exactly this immune system dysfunction occurs is less understood. There is likely an interplay of genetic and environmental factors, including:

• Infectious diseases, such as the Epstein-Barr virus
• Genetic predisposition
• Vitamin D deficiency
• Geographical location far from the equator
• Smoking

Gout

Gout is caused by high levels of uric acid in the body, which then collect as crystals in certain joints.

Like MS, gout can be caused by a combination of factors, including genetics, environment, and lifestyle. Unlike MS, as well as other forms of arthritis, gout is not caused by an immune system dysfunction.

Some causes and risk factors of gout include:

• Genetic predisposition
• High-purine diet
• Heavy alcohol use
• Certain medications, like diuretics
• Medical conditions, such as chronic kidney disease
• Having obesity
  

Diagnosis 

Multiple Sclerosis

Diagnosing MS can be tricky because there is no one single test to determine the presence of the disease. Your healthcare provider may suspect MS based on your medical history and symptoms and begin the complex process of diagnosing it based on multiple tests. These tests include:

• Blood tests (to rule out other conditions)
• Magnetic resonance imaging (MRI)
• Spinal tap
• Evoked potentials tests (EPTs)

Based on these tests and the McDonald criteria (the current diagnostic criteria for MS), your healthcare provider will determine if you meet the requirements for MS.

Gout

A healthcare provider can often suspect gout based on a visual exam of any red, swollen, or painful joints, as well as a verbal history of your symptoms.

They may also run a synovial fluid analysis to look for monosodium urate crystals. This is considered the gold standard diagnostic test for gout.

Treatment

Multiple Sclerosis

There is no cure for MS, but treatment can help manage symptoms and limit disease progression or relapses. Treatment for MS varies for each person, but may include:

• Disease-modifying therapies (DMTs)
• Prescription medications for MS symptoms
• Lifestyle changes, like sleep hygiene and dietary changes
• Physical therapy
• Occupational therapy
• Complementary and alternative medicine (CAM) therapies, such as acupuncture or supplements

Gout

Treatment for an acute gout flare may involve:

• Over-the-counter (OTC) or prescription anti-inflammatory medication
• Resting the joints
• Applying hot or cold compresses

Long-term gout treatment includes making certain lifestyle adjustments, such as eating a diet low in purines, quitting alcohol use, achieving a healthy weight, and more.

Prevention 

Multiple Sclerosis

Certain MS risk factors—including age, sex, and genetics—you have no control over. However, some things you can do to lower your risk of developing MS include:

• Quitting smoking
• Maintaining a healthy weight
• Monitoring vitamin D levels
• Living closer to the equator, which influences levels of vitamin D

Gout

Gout can be greatly influenced by a person's lifestyle. Eating a diet low in purines, which means limiting certain foods such as red meat, organ meat, seafoods, and beer, can help prevent gout.

Being at a healthy weight, reducing stress, and managing other health conditions can also help prevent an onset of gout.

Summary

Gout and MS are two entirely different health conditions. However, they are both influenced by uric acid. It's found in high levels among people with gout and in low levels among people with MS.

Uric acid has antioxidant properties. When it is low, you may have less protection from neurological damage found in MS. However, when uric acid levels are high, it can lead to inflammation and gout.

A Word From Verywell

Scientists are still trying to understand the role of uric acid in MS. Undoubtedly, the connection is complex and requires more investigation. It may take years to tease out the link between gout and MS. In the meantime, it's helpful to be aware of the signs and symptoms of both gout and MS and discuss any concerns you have with a trusted healthcare provider.