Gout in the Hands: Signs, Causes, and Which Joints Are Affected

Gout is an inflammatory arthritis in which urate crystals are deposited in a joint. Most often the first attack occurs in the big toe, but gout in the hands affects the fingers and hands, and then it can easily be confused with other arthritides. Below are the signs, causes, and tests that help make an accurate diagnosis.

Can gout occur in the hands, and which joints does it affect

Yes, it can. Gout is a systemic chronic metabolic disease, not a disease of a single joint: urate crystals are deposited in various tissues. The typical location is the big toe, but inflammation also arises in the feet, ankle, knee, elbow, wrist joints, and the joints of the hands. In the hands, inflammation can arise in the joints of the fingers, hands, and wrist: there, pain, swelling, and redness also appear suddenly.

Attacks often begin in the big toe or in the lower limb. Usually one joint becomes inflamed at a time.

Causes of gout in the joints of the hands

The underlying cause is hyperuricemia, an elevated level of uric acid in the blood. It is formed during the breakdown of purines, which are present in body tissues and in foods, and it is excreted by the kidneys. If there is too much uric acid or it is poorly excreted, needle-shaped crystals form in the joints, causing inflammation and pain. Hyperuricemia itself is not the same as gout and does not cause attacks in everyone.

Gout affects about 2% of residents of the USA and Europe; men are affected 7–19 times more often, with a peak at ages 40–50 in men and at age 60 and older in women.

The following increase the likelihood of gout:

• male sex and age: among men aged 55–65, gout occurs in 4–6%;
• excess weight, alcohol, especially beer, a lot of red meat, organ meats, fructose;
• menopause, use of diuretics and certain other medications, elevated cholesterol, hypertension;
• kidney disease, osteoarthritis, diabetes, heart failure, psoriasis, heredity;
• a prior surgery or joint injury.

An attack is triggered by an illness with a high fever, heavy eating, a lot of alcohol, dehydration, or joint injury.

First signs of gout in the fingers and hands

An attack begins suddenly, often at night: intense pain, swelling, redness, and heat appear in one joint. The pain can be so severe that it wakes the person. Redness is clearly visible on light skin, while on olive and dark skin it may be less obvious. An attack lasts a week or two, then resolves, and between attacks there may be no symptoms at all.

Without treatment, attacks become more frequent and longer, and tophi form under the skin — dense deposits of urates. In the hands they occur on the fingers, and also on the auricles and elbows.

How gout of the hands differs from other types of arthritis

Pseudogout causes similar symptoms and is sometimes mistaken for gout: calcium pyrophosphate, rather than sodium urate, is deposited in the joint. When the picture is unclear, a fluid sample is taken from the inflamed joint and examined for crystals.

How gouty arthritis is diagnosed

The doctor asks about symptoms, examines the joints, and clarifies dietary and alcohol habits. Laboratory testing determines the level of uric acid in the blood or urine. When the picture is unclear, the patient is referred to a rheumatologist: a fluid sample is taken from the inflamed joint with a thin needle and examined under a microscope. If aspiration cannot be performed, ultrasound or a special CT scan is ordered.

An elevated uric acid level is not a diagnosis in itself: hyperuricemia occurs in 4–12% of the population, whereas gout is noticeably less common.

Complications and when to see a doctor

With recurrent attacks without treatment, chronic gout develops: joints are damaged, tophi become painful, can damage bones and soft tissues, and lead to joint deformity. Kidney stones and chronic arthritis are possible, although the latter is rare.

See a doctor at the first attack in one's life, and also if a person is already being followed for gout but usual measures are not helping.

Gout itself is not a reason to call an ambulance. Calling 103 or 112 is necessary if sudden joint pain and swelling are accompanied by worsening pain, a very high fever or a feeling of heat and chills, nausea, or inability to eat: this may be an infection inside the joint.

It makes sense to come to an appointment with questions: whether the diagnosis has been confirmed by joint fluid analysis, which tests are needed and how often to monitor uric acid, which of my medications and eating habits maintain a high urate level, and what to do during the next attack. This material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer