Gout Does Not Cause Elevated ANA Levels
Gout does not cause an increase in antinuclear antibody (ANA) levels. In fact, research specifically examining antibody immunity in gout patients found that ANA was not detected in a single patient with gout among 77 cases studied 1.
Evidence from Gout Populations
- A study examining 77 patients with gout (including both acute attacks and attack-free periods) found zero cases of positive ANA, despite detecting other antibody abnormalities such as IgM rheumatoid factor in 5 patients 1.
- This finding strongly suggests that gout itself does not trigger ANA production, distinguishing it from true autoimmune connective tissue diseases where ANA is commonly present 1.
Understanding ANA Positivity in General Populations
While gout doesn't cause ANA elevation, it's important to understand that ANA can be positive in healthy individuals:
- The general healthy population has an ANA positive rate of approximately 7%, with higher rates in women (10.2%) compared to men (4.6%) 2.
- ANA positivity in healthy people is associated with metabolic abnormalities, inflammation, and immune dysfunction, but not specifically with gout 2.
- Low-titer ANA can occur with chronic infections, hematological malignancies, vitamin D deficiency, and certain medications—none of which are direct consequences of gout itself 3.
Clinical Implications
If a patient with gout has a positive ANA, consider alternative explanations:
- Coincidental finding: Given the 7% baseline positivity rate in healthy populations, the ANA may be unrelated to the gout 2.
- Coexisting autoimmune disease: High-titer ANA (≥1:640) with symptoms like joint pain, fever, abnormal urinalysis, or skin rash suggests a true autoimmune condition rather than gout 4.
- Inflammatory state: While gout causes acute inflammation with elevated ESR and other acute phase reactants, this inflammation does not trigger ANA production 5, 1.
Common Pitfall to Avoid
Do not assume that a positive ANA in a patient with hyperuricemia or gout indicates an autoimmune overlap syndrome. The evidence shows these are independent findings 1. Instead, evaluate the ANA titer and clinical context: high titers (≥1:640) with specific autoimmune symptoms warrant further investigation for connective tissue diseases, while low titers may represent background positivity unrelated to either condition 4, 3.