Gout finger: what to do?

Gout finger: what to do?

In the case of the metabolic disease gout, deposits of uric acid crystals in the joints lead to painful joint inflammation. Although the big toe is most commonly affected, about five per cent of gout attacks also affect the finger joints. A gouty finger is often particularly uncomfortable because the mobility of the entire hand can be painfully restricted. With us, you will learn which signs point to gouty fingers and what you can do to prevent them.

 

Increased uric acid as a cause

Gout (arthritis urica) is the symptom of abnormally high uric acid levels 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 synovial fluid. The result is a sudden inflammation of the affected joint.

Therefore, the widespread assumption that you can get gout by “cracking your fingers” is incorrect. Get more information about the causes of gout here.

 

Gout fingers are a rare form of gout.

In about 80 to 90 per cent of cases, a gout attack occurs in a joint of the lower extremity – so a gouty finger is instead a rarity. This form of gout on the fingers is also called chiragra. The metatarsophalangeal joint is most commonly affected – less frequently, gout occurs in the joints of the other fingers.

It is not exactly known why some people develop finger gout, and others do not. A possible cause is previous damage to the finger joint (e.g. due to an earlier injury or arthrosis), which means that the uric acid crystals are preferentially deposited on this joint.

Sudden onset of symptoms in finger gout

In the case of a gouty finger, the characteristic signs of joint inflammation suddenly appear: the joint is reddened, overheated, swollen and painful. The mobility of the finger joint is usually restricted due to the pain and swelling.

The finger can also be very sensitive to touch, so even a light touch, such as through a duvet, is unbearable. Usually, there is also a fever and a general feeling of illness. Nauseatachycardia or headaches can also occur.

Typically, the symptoms appear unexpectedly out of total health – the attack often begins at night or early in the morning. After a few days to about two weeks, the symptoms disappear entirely, and the finger can be moved typically again. During this period, the skin over the affected joint often peels and itching occurs.

 

Gouty nodules: a symptom of chronic gout

If gout is not treated consistently, the disease can become chronic. So-called gout nodes (gout tophi) can develop due to uric acid deposits—small, painless lumps form in soft tissue, cartilage, or bone.

Außer an den Fingern können die Tophi auch an den Füßen, der Ohrmuschel oder den Ellenbogen auftreten. Zudem können Längsrillen in den Fingernägeln auf eine chronische Gichterkrankung hinweisen.

In seltenen Fällen können sich Gichttophi an den Sehnenscheiden der Hand bilden. Dies kann dann eine schmerzhafte Sehnenscheidenentzündung oder sogar ein Karpaltunnelsyndrom zur Folge haben.

Anzeichen hierfür sind unter anderem Schmerzen in den Fingern oder im Handgelenk sowie ein Kribbeln oder Taubheitsgefühl im Daumen, Zeigefinger und Mittelfinger. Aufgrund der meist frühzeitig beginnenden Therapie ist ein chronischer Verlauf der Gicht heutzutage jedoch recht selten.

Diagnostik: Harnsäurewerte nicht immer erhöht

Da ein Gichtfinger eine seltene Form von Gicht ist, liegt die Diagnose nicht immer nahe. Umso wichtiger ist eine zielführende Diagnostik, um andere Ursachen für eine Gelenkentzündung auszuschließen.

Neben dem Beschwerdebild liefern mögliche Auslöser des Anfalls wie eine vorangegangene Infektionskrankheit, Überanstrengung des Gelenks, schweres Essen, Alkoholgenuss oder auch eine Fastenkur erste Hinweise auf die Erkrankung. Eine Blutuntersuchung zeigt in der Regel erhöhte Entzündungswerte, der Harnsäurespiegel kann jedoch im Akutstadium normal sein und sollte daher nach zwei bis vier Wochen erneut kontrolliert werden.

Gelenkpunktion in Ausnahmefällen

In unklaren Fällen können außerdem eine Ultraschalluntersuchung oder ein Röntgenbild des Fingergelenks zur Diagnosestellung beitragen. So wird der Zustand von Sehnen, Knorpeln und Bändern überprüft. Auch Nierensteine oder das Vorliegen eines Harnstaus können im Ultraschall erkannt werden.

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 to diagnose gout on the fingers if a bacterial joint infection has to be ruled out as the cause of the inflammation. The joint fluid removed is used to detect any uric acid crystals in the sample under the microscope.

If the affected person responds to medication with the active ingredient colchicine, which has an anti-inflammatory effect, during an acute gout attack, this could also indicate gout disease.

 

Other causes of inflammation of the finger joints

The symptoms of gout finger are not always characteristic and can also indicate other diseases. For example, the following other causes can be responsible for finger problems:

  • Infektion des Gelenks (septic Arthritis)
  • acute inflammatory attack due to joint wear (activated osteoarthritis)
  • Rheumatism (rheumatoid arthritis)
  • reactive arthritis (joint inflammation after a bacterial infection – for example of the gastrointestinal tract or respiratory tract)
  • systemic  lupus  erythematosus
  • Pseudogout (deposits of calcium crystals)

Treat gout fingers

An acute gout attack on the finger is usually first treated with an anti-inflammatory painkiller such as  diclofenac  or  ibuprofen  . If there are contraindications to these active ingredients, the doctor can alternatively  prescribe cortisone  or a similar active ingredient in tablet form. The active ingredient colchicine is now only used in comparatively small doses in order to keep the otherwise sometimes severe side effects as low as possible.

In addition, medications such as nonsteroidal anti-rheumatic drugs (NSAIDs), alkaloids or biologics can be used in the event of an acute gout attack.

Since cold has a relieving effect on inflammation, cold compresses and cryotherapy can be useful for treatment. Homeopathy medicines can also   be used to supplement drug treatment.

However, surgery should only be considered for chronic gouty fingers and only in exceptional cases.

Home remedies for gout fingers

In the case of acute symptoms, a few home remedies and tips can help to relieve the symptoms of gout in the fingers.

  • Protect the affected fingers and keep your hand slightly elevated.
  • Cool your fingers with an ice pack wrapped in a kitchen towel or an envelope of chilled quark.
  • Drink at least one and a half liters of fluid every day to flush uric acid from the body. Low-purine  drinks such as water or  tea are best  .

 

Long-term therapy: reduce uric acid levels

After the first acute gout attack, therapy with a drug that lowers uric acid is usually necessary to prevent gout from progressing. In most cases, the active ingredient is allopurinol. It belongs to the uricostatics group and inhibits uric acid formation in the body.

Alternatively, so-called uricosurics such as probenecid can be used. They work by increasing uric acid excretion via the kidneys. However, these medications are not cures for gout – changing your diet is essential to avoid a gout finger’s recurrence.

Mostly good prognosis

If gout is diagnosed early, the prognosis is usually excellent. Early treatment can usually prevent permanent damage to the finger joints and bones, as well as a chronic course.

If gout tophi has already formed, it often resolves with drug therapy. Surgery for a chronic gout finger is only necessary in exceptional cases – for example if the tophi cause carpal tunnel syndrome or a tendon rupture.

Prevent gout fingers

There are several things you can do to prevent gout attacks by changing your lifestyle and diet – this also applies if you have only been diagnosed with elevated uric acid levels without ever having a gout attack:

  • Low-purine diet: Since uric acid is produced when purines are broken down, you should eat as few foods high in purines as possible – you can learn more about the gout diet here.
  • Reduce alcohol consumption: Alcohol inhibits the excretion of uric acid and can trigger a gout attack. Beer (including non-alcoholic beer ) also contains purines and should be avoided if possible.
  • Drink enough: To support the excretion of uric acid via the kidneys, you should drink at least 1.5 litres of liquid daily.
  • Avoid fasting: During more extended periods of hunger, uric acid accumulates. You should, therefore, avoid fasting cures and crash diets.
  • Aim for average weight: Being overweight increases uric acid levels and is a risk factor for gout. However, be sure to lose weight slowly to avoid uric acid spikes.

 

 

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