Gout in the Thumb: Could Your Thumb Pain Be a Sign of Gout?

Medically reviewed by David Ozeri, MD

Gout is a type of inflammatory arthritis that develops when the body has high uric acid levels, known as hyperuricemia. Gout often affects the big toe but can also affect other joints, including the thumb. If you have burning pain in a thumb joint, you could be experiencing a gout attack, also called a flare or flare-up.

Gout in the thumb is rare, but it can affect the carpometacarpal (CMC) joint of the thumb or the metacarpophalangeal (MCP). The CMC joint connects the thumb to the wrist and plays a role in the normal functioning of the thumb. The MCP joint is the large joint within the hand, where the thumb joint meets the hand bones. It connects to the CMC joint.

A gout attack in the thumb can be extremely painful because of how often you use your thumbs, from turning doorknobs to writing to grasping a cup. The pain results from active inflammation, which causes swelling, tenderness, redness, and warmth in the affected thumb.

This article covers the causes of gout in the thumb, its prevalence, and other causes of thumb pain, treatment, and more.

What Causes Gout in the Thumb?

Hyperuricemia causes gout. Typically, the kidneys flush out uric acid through the urine, but sometimes, there is just too much for the kidneys to filter. Excess uric acid builds up in the bloodstream. Some uric acid can move from the bloodstream into the joints and form crystals.

When this happens, your immune system will see the urate crystals as foreign invaders and activate an inflammatory response. Symptoms of an inflammatory response in an affected joing include:

• Swelling

• Pain

• Tenderness

• Redness

• Warmth

Certain factors increase gout risk.

Genes and Family History

Your risk for gout is higher if the condition runs in your family. The heritability for hyperuricemia (meaning the chance of having a condition due to genetic variants) falls between 45% and 73%. Your risk for gout is higher if you have a first-degree relative (a parent or sibling) with the condition. 

Medications

Certain medicines, such as diuretics (water pills), beta-blockers (used to treat high blood pressure), cyclosporine (an immunosuppressant), and aspirin, can increase your risk for high uric acid levels and gout.

Underlying Health Conditions

Some health conditions, including high blood pressure (hypertension), kidney diseases, and diabetes, can increase uric acid levels in the bloodstream and lead to gout. People with kidney disease are especially at risk because the kidneys play a crucial role in ridding the body of uric acid, and impaired kidney function can lead to higher uric acid levels.

Hand Injuries

If you get frequent gout attacks, you should avoid injuries to your fingers or thumb. A thumb injury could cause uric acid buildup in the thumb joints. Finger injuries might also lead to a gout flare-up in an affected finger. 

Diet

A diet high in purines can result in high uric acid levels. Purines are common compounds in red meat, organ meat, and seafood. They can also be found in alcohol, especially beer, and sugary drinks, including soft drinks.

Studies also suggest being overweight increases the risk of gout, and losing weight can lower your risk. Weight loss can also lessen overall stress on your weight-bearing joints.

Related: Gout: Avoiding Foods That Increase Uric Acid

Age and Sex

People assigned male at birth have a higher risk for gout—mainly because people assigned female usually have lower uric acid levels. However, after menopause, uric acid levels tend to increase and affect everyone similarly.

People assigned male at birth will develop gout earlier (before age 50), while those assigned female at birth tend to develop gout after menopause.

How Common Is Gout in the Thumb?

A 2019 study in Arthritis & Rheumatology found that nearly 10 million Americans have gout. While gout can affect any joint, the thumb is an unusual place for urate crystals to develop.

The big toe is the most common joint for a gout flare. Other common areas are the knee, elbow, wrist, and finger joints.

Is Your Thumb Pain Due to Gout or Something Else?

Gout attacks can cause excruciating pain, which makes them hard to miss. However, gout is not the only condition or type of arthritis that affects the thumb. These other conditions are more likely to cause thumb pain.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system malfunctions and attacks healthy tissues, mainly the synovial linings of joints. RA frequently affects the joints of the hands, including the fingers and thumbs.

Like gout, thumb RA causes inflammation of the CMC and MCP joints, leading to severe pain and swelling. These symptoms might make it harder to carry out daily tasks, especially those involving grasping and gripping objects, such as writing, holding a glass or mug, or using kitchen tools.

Related: Gout vs. Rheumatoid Arthritis: What Are the Differences?

Psoriatic Arthritis

Like RA, psoriatic arthritis (PsA) is an autoimmune arthritis. Many people with PsA also have psoriasis, an autoimmune skin disease.

When PsA affects the hands, inflammation can cause swelling and stiffness in the hand and finger joints. People with PsA will have inflammation at the thumb's interphalangeal (IP) joint, which is the first joint, near the tip of the thumb and right below the fingernail.

Related: Psoriatic Arthritis vs. Gout: What Are the Differences?

Pseudogout

Pseudogout is an inflammatory arthritis that forms when calcium pyrophosphate crystals deposit in the joints and soft tissues. It can cause similar symptoms to gout and frequently affects the wrists and hands.

It is essential to distinguish between gout and pseudogout as the treatments are different. Your healthcare provider can do this by examining a fluid sample from the affected thumb joint to determine the type of crystals involved in the inflammation.

Related: Pseudogout vs. Gout: What’s the Difference?

Injury or Infection

A swollen thumb can result from a bacterial nail infection or an injury. A thumbnail infection can cause pain, redness, and swelling. Any injury to the thumb's bones and ligaments can lead to pain and swelling of the thumb joints.

Osteoarthritis

The most common type of arthritis of the thumb is osteoarthritis (OA). OA can cause damage to the thumb joints due to natural wear and tear over time.

OA causes cartilage to wear away, which eventually causes bone-on-bone pain (bones rubbing against each other) and joint damage. Cartilage is the material that acts as a cushion and allows bones to glide gently against each other.

Combination of Conditions

Gout and other conditions that cause joint pain, specifically thumb pain, can coexist. For example, one 2019 study found up to 6% of people with RA also had gout. Gout can also coexist with PsA and osteoarthritis. RA, PsA, and OA are all conditions that might increase your risk for gout. 

It can be hard to identify which arthritic condition is causing your thumb pain by relying on symptoms alone. However, your healthcare provider can determine the cause using various tests, including imaging, blood work, and joint fluid aspiration.

A Telltale Sign of Gout in the Thumb: Tophi

Tophi are a symptom of gout. They are large, hardened masses of uric acid crystals within and around the joints. These masses can cause pain, joint deformity, and limited range of motion.

Tophi can affect any joint, including in the fingers and thumbs. It is a sign of advanced or chronic gout.

When tophi affect the small joints of the thumbs and fingers, physical changes and limited movement will occur. Joint damage or infection can also occur.

Related: How Long Does Gout Last?

How Providers Diagnose Gout in the Thumb

A gout attack of the thumb or other joint area can last up to 10 days. However, if you seek treatment, your recovery time could be shorter. If you think you might have gout, see a healthcare provider.

A healthcare provider will typically examine your thumb for lumps that might indicate tophi. You will be asked about your symptoms, when they started, and whether this is your first gout flare-up.

The healthcare provider will also want to know about any underlying conditions, medications you are taking, and any family history of gout or other arthritic conditions.

If your healthcare provider suspects gout or is unsure of the cause of symptoms, they will request additional tests, including:

• Blood test: A uric acid blood test can check your body's uric acid levels. However, high uric acid levels do not always mean gout.

• Joint fluid test: Also called joint aspiration, this test involves taking fluid from the painful joint with a needle. The fluid is then taken to a lab and examined under a microscope for urate crystals.

• Imaging: X-rays can help rule out other forms of arthritis. An ultrasound can look for uric acid deposits in the affected joint.

Treatment for Gout in the Thumb

Treatment for an acute (short-term) gout flare of the thumb typically involves medications to reduce inflammation and manage pain.

Treatment options for an acute flare include:

• Over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain and bring down inflammation

• Corticosteroids to manage acute flares, which are prescribed for short periods

• Colchicine, which can be given to treat gout and prevent future flares

If you have repeat gout flare-ups, your healthcare provider may prescribe additional treatments to prevent gout from becoming chronic and leading to tophi.

Such medications include:

• Aloprim or Zyloprim (allopurinol) to prevent high uric acid levels

• Uloric (febuxostat) to reduce uric acid formation from purines

• Probalan (probenecid) to assist the kidneys in filtering uric acid

• Krystexxa (pegloticase), an intravenous (IV) drug, to break down urate crystals

Surgery is recommended in cases where there is thumb damage, nerve compression, or tophi infection. Fortunately, surgery is rarely needed to treat gout-affected joints.

Related: How Gout Is Treated

Lifestyle and Self-Care

Some lifestyle modifications and self-care measures can help you to manage gout symptoms and prevent flares.

People with gout should avoid foods and beverages high in purines. Such foods and beverages include:

• Alcoholic beverages

• Sugary beverages

• Some fish and shellfish, including anchovies, sardines, herring, scallops, trout, crab, and lobster

• Processed meats, hot dogs and luncheon meats

• Organ meats, including kidney and liver

• Fatty meats, including beef, pork, and duck

In addition to watching what you eat, you should stay hydrated, which can reduce uric acid levels and recovery time.

Applying ice packs and cold compresses to the affected thumb can help manage pain and swelling. You can apply ice for up to 20 minutes several times a day.

Last, avoid using the affected thumb during the gout flare. Ask your healthcare provider if a splint or brace might help to manage your thumb gout symptoms.

Related: How to Prevent Gout

Summary

Gout is a type of arthritis that develops when uric acid crystals are deposited in a joint. Risk factors for gout include family history, older age, being assigned male at birth, certain medical conditions and medications, and a diet high in purines.

A thumb injury could lead to a build-up of uric acid crystals in one of your thumbs, and if the levels of uric acid are not managed, you could experience a gout flare-up in the thumb.

Contact your healthcare provider if you develop a sudden and severe swelling and pain in your thumb. This is especially important if you have already been diagnosed with gout or are at high risk for the condition.

Treatment can help reduce symptoms and prevent future attacks, chronic gout, and tophi. Surgery is rarely needed to treat gout in the thumb, but it may be needed if joint damage related to tophi occurs.

Read the original article on Verywell Health.