Gout Finger: What to Do?

In the metabolic disease gout, deposits of uric acid crystals in the joints cause painful joint inflammation. Although the base joint of the big toe is most commonly affected, in about five percent of cases, an attack of gout also occurs in the joints of the fingers. A gout finger is often particularly unpleasant, as the mobility of the entire hand can be painfully restricted. With us you will learn which signs indicate a gout finger and what you can do against gout on the finger.

Increased uric acid as a cause

Gout (arthritis urica) is the symptom of abnormally elevated uric acid concentration in the blood (hyperuricemia). If the uric acid level rises rapidly – for example, after a feast or excessive alcohol consumption – uric acid crystals precipitate in the joint fluid. The result is a sudden inflammation of the affected joint. The widespread assumption that you can get gout by “cracking your fingers” is therefore not true. Get more detailed information about the causes of gout here.

Gouty fingers: rare form of gout.

In about 80 to 90 percent of cases, an attack of gout occurs in a joint of the lower extremity – so a gout finger is a rarity. The thumb base joint is most commonly affected – this form of gout is also called chiragra. More rarely, gout occurs in the joints of the other fingers. It is not known exactly why gout occurs in some people’s fingers and not in others. One possible cause of a gouty finger is previous damage to the finger joint – for example, from a previous injury or with osteoarthritis – which causes uric acid crystals to be deposited preferentially at that joint.

Sudden onset of symptoms

In a gout finger, the characteristic signs of joint inflammation appear suddenly: The joint is red, overheated, swollen, and very painful. Usually, the mobility of the finger joint is limited due to the pain and swelling. The finger can also be very sensitive to touch, so that even a light touch, as through a bedspread, is unbearable. In most cases, fever and a general feeling of illness are also present. Typically, the symptoms occur unexpectedly out of full health – often the attack begins at night or early in the morning. After a few days to weeks, the symptoms disappear completely and the finger can be moved normally again.

Gout tophi: signs of chronic gout

If gout is not treated consistently, the disease can become chronic. Then, uric acid deposits can cause so-called gout tophi. These are small, painless nodules that form in soft tissues, cartilage tissue, or on bone. In addition to the fingers, tophi can also occur on the feet, pinna or elbows. In addition, longitudinal grooves in the fingernails may indicate chronic gout disease.

Chronic course rare

In rare cases, gouty tophi can form on the tendon sheaths of the hand. This can then result in painful tendonitis or even carpal tunnel syndrome. Signs of this include pain in the fingers or wrist as well as tingling or numbness in the thumb, index finger and middle finger. However, due to therapy that is usually started early, a chronic course of gout is quite rare nowadays.

Diagnostics: uric acid levels not always elevated

Since a gout finger is a rare form of gout, the diagnosis is not always obvious. All the more important is a target-oriented diagnosis to exclude other causes of joint inflammation. In addition to the symptoms, possible triggers of the attack, such as heavy eating, alcohol consumption or even a fasting cure, provide initial indications of the disease. A blood test usually shows elevated inflammation levels, but uric acid levels may be normal in the acute stage and should therefore be checked again after two to four weeks.

Joint puncture in exceptional cases

In unclear cases, an ultrasound examination or an X-ray of the finger joint may also help to establish the diagnosis. A joint puncture on the finger is relatively difficult to perform due to the small amount of synovial fluid and is therefore usually only used in the diagnosis of a gouty finger when a bacterial joint infection must be ruled out as the cause of the inflammation.

Other causes of inflammation of finger joints

The symptoms of a gouty finger are not always characteristic and may indicate other conditions. For example, the following other causes may be responsible for finger discomfort:

  • Infection of the joint (septic arthritis).
  • Acute inflammatory episode in joint wear (activated osteoarthritis).
  • Rheumatism (rheumatoid arthritis)
  • Reactive arthritis (joint inflammation after a bacterial infection – such as the gastrointestinal tract or respiratory tract).
  • Systemic lupus erythematosus
  • Pseudogout (deposits of calcium crystals).

Treat gout fingers

An acute attack of gout on the finger is usually first treated with an anti-inflammatory painkiller such as diclofenac or ibuprofen. If there are contraindications to these agents, the doctor may alternatively prescribe cortisone or a similar agent in tablet form. In contrast, the active ingredient colchicine, which used to be frequently prescribed for gout of the finger, is now rarely used because of its severe side effects. Since cold has a soothing effect on inflammation, cold compresses and cryotherapy can be useful for a gout finger. Medicines from homeopathy can also be used to supplement the drug treatment. Surgery, on the other hand, should only be considered for a chronic gout finger and only in exceptional cases.

Continuous therapy: lower uric acid levels.

After the first acute attack of gout, therapy with a uric acid-lowering drug is usually necessary to prevent progression of the gout. In most cases, the active ingredient allopurinol, which reduces the formation of uric acid in the body, is used for this purpose. Alternatively, so-called uricosurics such as Probencid can be used. They work by increasing uric acid excretion via the kidneys. However, these drugs are not cures for gout – a change in diet is therefore inevitable to avoid the recurrence of a gout finger.

Prevent gout finger

To prevent a gout finger, you can do a number of things by changing your lifestyle and diet – this is true even if you have only been diagnosed with elevated uric acid levels without a gout attack to date:

  • Low-purine diet: since uric acid is formed when purines are broken down, you should make sure to eat as few purine-rich foods as possible – you can find out more about diet for gout here.
  • Reduce alcohol consumption: Alcohol inhibits uric acid excretion and can thus trigger a gout attack. Beer also contains purines and should therefore be avoided if possible.
  • Drink enough: to support the excretion of uric acid through the kidneys, you should drink at least 1.5 liters of fluid per day.
  • Avoid fasting: During prolonged periods of starvation, uric acid accumulates more. You should therefore avoid fasting cures and crash diets.
  • Aim for normal weight: Excess weight promotes an increase in uric acid levels and is therefore a risk factor for gout. However, be sure to reduce your weight only slowly to avoid a rise in uric acid.

Mostly good prognosis

If a gout finger is diagnosed in time, the prognosis is usually very good. Through early treatment, permanent damage to the finger joints and bones, as well as a chronic course can usually be prevented. If gouty tophi have already formed, they often resolve with drug therapy. Surgery for a chronic gouty finger is necessary only in exceptional cases – for example, if the tophi causes carpal tunnel syndrome or tendon rupture.