Stiff joints in the hand can be a symptom of several types of arthritis. But if you also have burning pain, such as at the base of the thumb, you could be having a gout flare in the thumb.
Thumb pain caused by a gout attack can be especially debilitating because we use our thumbs so often. Every time you pick up your phone, grab a doorknob, or grasp a mug, your gout-inflamed thumb is forced to move at a joint where uric acid crystals are causing severe inflammation and extreme pain.
“Most commonly, gout pain in any joint is more intense than that of pain from other kinds of arthritis, such as rheumatoid arthritis,” says Theodore Fields, MD, Attending Rheumatologist at Hospital for Special Surgery and Professor of Clinical Medicine at Weill Cornell College of Medicine in New York City.
Gout flares are usually associated with signs of active inflammation, including redness, heat, swelling, and pain. Gout in the thumb can occur at the middle joint (the knuckle) or at the joint where the thumb meets the hand.
What Causes Gout in the Thumb?
Gout develops when the body has high levels of uric acid, a normal waste product. This is known as hyperuricemia.
Uric acid is normally excreted through the body via the kidneys, but in some people, levels can remain high and uric acid can start to accumulate and crystallize in various joints. When these uric acid crystals affect the joints in the thumb, it can cause gout in the thumb, making it red, swollen, and hot to the touch, according to the Cleveland Clinic.
Gout flares commonly affect the big toe, especially at first, but they can occur in joints all over the body.
Genes and Family History
Research over the past decade has increasingly identified a link between a genetic predisposition and high uric acid levels. For example, in a 2012 study, researchers looking at a large number of people’s unique genomes (a person’s set of genetic instructions) found that patients with gout often shared a similar variation on a gene that affects kidney function. A 2018 study further identified several genes that influence how the body gets rid of uric acid.
Another factor that contributes to high uric acid levels is taking certain medications, such as diuretics (water pills) for high blood pressure or cyclosporine, an immunosuppressive drug that patients with a transplanted organ take.
Underlying Health Conditions
Health conditions such as obesity, insulin resistance, high cholesterol, heart disease, and kidney disease are linked with gout, and should be looked for in people with gout.
Some gout flares in hand joints have also been documented in patients who experience an injury or surgery to their hand, according to the American Society for Surgery of the Hand.
While eating foods high in purines, which get broken down into uric acid during digestion, can contribute to gout flares, diet alone is not commonly the main cause of gout. High-purine foods include certain seafood, organ meats, alcohol, and sugar-sweetened beverages.
Age and Sex
Other risk factors associated with gout are age and sex, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout is more common in men than in women (although women certainly do get gout; it more commonly affects women after menopause). And while gout usually develops in middle age, it can affect younger people too.
How Common Is Gout in the Thumb?
Considered a type of arthritis, gout is very common. It affects nearly 10 million U.S. adults, according to a 2019 study in the journal Arthritis & Rheumatology. However, “the thumb is quite an unusual place for gout to make its first appearance,” Dr. Fields explains.
He says gout can occur in any joint in the body, but the most common spot for a first flare of gout is at the bunion joint of the big toe, followed by the mid-foot, then the ankle and the knee.
“There’s some thought that gout in the lower extremity, and especially the big toe, may happen earlier than in other joints because of pressure from walking,” Dr. Fields explains. “In the first toe, it has been postulated that it being the coolest part of the body, you get more gout since we know that gout crystals are more likely to come out of solution in cooler temperatures.”
But gout can develop in any joint in the hand, including the thumb but also in finger joints as well as the wrist, elbow, and even the shoulder. Gout tends to affect more joints in the body the longer you have it and if it is not well-controlled.
If you experience a gout attack in your thumb, it is likely a sign of advancing gout, with previous flares occurring in other joints such as your big toe. If you suspect you have gout symptoms in your thumb, fingers, or hand you should seek medical attention.
Is Thumb Pain Due to Gout — or Something Else?
Many gout attacks are so painful that they are not subtle or easy to miss. However, not all gout flares present in the same way (although gout pain is characteristically sharp rather than a dull ache). Answering yes to most of these questions could help determine that your thumb pain could be from gout in your thumb:
- Have you experienced sudden shooting pain in your thumb?
- Does this pain last for a day to a week or two and then subside or lessen?
- Do you notice redness and swelling around either thumb joint?
- Is your thumb back to normal after the pain and swelling goes away?
- Have you been experiencing sudden pain in your foot, ankle, or other joint prior to your thumb pain, especially with redness, heat, and swelling?
While the pain of a gout attack is distinct, other forms of arthritis could be to blame for thumb pain, including rheumatoid arthritis or psoriatic arthritis.
Rheumatoid arthritis is an autoimmune condition that causes joint pain and commonly affects the hands. However, it often causes symmetrical pain (affecting the same joint on both sides of the body at the same time) and is characterized by joint stiffness that is worse in the morning but lessens as the day goes on. Gout pain is usually not symmetrical.
Read more here about rheumatoid arthritis vs. gout.
Psoriatic arthritis — another autoimmune condition — can also cause joint pain in the hands but it also commonly occurs in people who also have psoriasis (scaly red skin patches), and fingernail and toenail changes, such as pits, ridges, thickening, and crumbling of the nail.
Read more here about psoriatic arthritis vs. gout.
Burning thumb pain at the joint can also be the result of pseudogout, which is a condition due to the buildup of different kinds of crystals called calcium pyrophosphate. These crystals look different than gout urate crystals under a microscope. Your doctor would be able to differentiate gout crystals from pseudogout crystals when examining a sample of fluid from your inflamed thumb joint.
Read more here about symptoms of pseudogout.
Injury and Infection
Injury, such as a stress fracture, or an infected joint could also be causing your thumb pain.
When the protective cartilage between the bones in your thumb wear down, this form of arthritis called osteoarthritis can also cause pain in your thumb joints. Thumb osteoarthritis usually causes a characteristic cracking or clicking sound as the bones move against each other.
Combination of Conditions
Making matters more confusing, there is a chance you could experience gout and another form of arthritis at the same time. For example, a 2019 study in Arthritis Care & Research found that about 6 percent of people with rheumatoid arthritis also had a diagnosis of gout.
There is also overlap between osteoarthritis and gout; research suggests that joints affected by osteoarthritis may be more prone to develop gout.
And there may be overlap between psoriasis/psoriatic arthritis and gout. A study in the Annals of Rheumatic Disease found that psoriasis and psoriatic arthritis are associated with having an increased risk of developing gout.
Rest assured, your doctor can help identify what is causing your thumb pain with imaging, blood tests, and by checking if fluid in your inflamed joint has the telltale uric crystals that signal gout.
Tophi: The Hard Bumps Under the Thumb Joint
Another telltale sign that your thumb pain is from gout is the presence of tophi — hard bumps right under the skin that can be small but also grow large and become very noticeable. Tophi are deposits of uric acid crystals that form under the skin in nodules. When tophi develop in your hand, the nodules can appear at any joint in your fingers or thumb .
Gout tophi are not usually painful but can feel tender during a gout flare, according to the Mayo Clinic.
Gout tophi usually take time to develop and can become visible after a person has had gout for many years, as noted in MedlinePlus.
How Doctors Diagnose Gout in the Thumb
When you see a primary care physician or rheumatologist for suspected gout in your thumb, your doctor will examine any bumps that could be tophi deposits. They may also X-ray your thumb and draw fluid from the site of the pain to look for uric acid crystals. You may get your blood drawn to measure your uric acid levels and to check for infection.
Be prepared to share all of your symptoms, as well as your medical history and any medications you are taking, advises the American Society for Surgery of the Hand.
Surgery is not commonly indicated for gout in thumb; however, a surgeon may very rarely need to be consulted in cases where gout in thumb is not treated, because the inflammation can wear joints down and cause damage to tendons.
Treatments for Gout in the Thumb
“For a flare of gout in the thumb, the treatment is similar to that of other sites of gout flares,” Dr. Fields explains.
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs (NSAIDs, colchicine, and glucocorticoids) are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
- Allopurinol (the most commonly used medication to lower uric acid levels)
Another medication called pegloticase (Krystexxa) may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
For most people, the goal is to get uric acid levels below 6 mg/dL. In some especially severe gout cases, such as when someone has tophi, the goal is a uric acid level below 5 mg/dL.
Allopurinol is the preferred first-line agent for urate-lowering treatment according to recommendations outlined in the 2020 American College of Rheumatology Guideline for the Management of Gout.
In addition, it’s important to make lifestyle changes that can help maintain healthy uric acid levels. This means losing weight if you’re overweight or obese.
For people who experience recurrent gout attacks, Dr. Fields recommends a low-purine diet. This limits alcohol, red meat, organ meats such as liver, shellfish, and high-fructose corn syrup as in regularly sweetened sodas. But keep in mind: “For most people with gout, diet isn’t enough, and they need medication to lower the uric acid — most commonly with the uric acid-lowering medication allopurinol,” says Dr. Fields.
Since gout in the thumb typically occurs later in the course of disease and is not the first sign of gout, it can be easily avoided if people seek medical attention for recurrent gout and adhere to their treatment, says Dr. Fields. If this is the case, people “will likely never get gout in the thumb, since their gout problem likely started in the foot or ankle and once on [medication like allopurinol] for a period of time gout almost always is ‘cured’ as long as the medication is continued.”
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Interview with Theodore Fields, MD, Attending Rheumatologist at Hospital for Special Surgery and Professor of Clinical Medicine at Weill Cornell College of Medicine in New York City
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