How can I tell osteoarthritis from arthritis types like gout?

The short version: osteoarthritis and gout differ in onset, location, and inflammation pattern, but the evidence here does not directly compare them.

The retrieved studies focus on knee osteoarthritis features, not on gout or a head-to-head comparison. One study from the MOST cohort found that knee OA pain patterns track with radiographic severity: knees with Kellgren-Lawrence grade 3 or 4 had about 3.7 times the odds of constant plus intermittent pain compared with knees with no OA [1]. That same study showed that longer OA duration also predicted more constant pain [1]. Gout, by contrast, typically strikes suddenly, often in the big toe, and resolves between attacks.

A 2025 trial on gout flares tested a new anti-IL-1β antibody (firsekibart) against etoricoxib in 125 Chinese adults. At 72 hours, firsekibart reduced pain by about 54 mm on a 100 mm scale versus 43 mm for etoricoxib, meeting non-inferiority and superiority [2]. Gout recurrence over 12 weeks was 6.6% with firsekibart versus 66% with etoricoxib [2]. That trial tells you about treating a gout flare, not about distinguishing it from OA.

The key clinical differences are not in these records but are well-established: OA comes on gradually, worsens with use, and improves with rest. Gout flares are rapid, intensely painful, red, and swollen, often with uric acid crystals in the joint fluid. A blood test for uric acid (above 6.8 mg/dL) supports gout but does not rule it out during a flare.

My call: if the stiffness came on suddenly with redness and swelling, suspect gout and get a joint fluid analysis. If it came on gradually and hurts more when you walk, it is likely osteoarthritis. Confidence: moderate for the OA pattern from the cited studies; the gout comparison relies on general clinical knowledge outside these records.