From the Research
Gout is less common in the hands compared to pseudogout. While gout typically affects the big toe (podagra) and other lower extremity joints like ankles and knees, pseudogout more frequently targets larger joints such as knees, wrists, and hands, particularly the triangular fibrocartilage of the wrist. When gout does affect the hands, it tends to involve the distal interphalangeal joints and can present with tophi (urate crystal deposits). Pseudogout, caused by calcium pyrophosphate crystal deposition, has a predilection for hand involvement, especially the second and third metacarpophalangeal joints. The distinction matters clinically because treatment differs: gout responds to urate-lowering therapies like allopurinol (starting at 100mg daily, gradually increasing to 300-600mg daily as needed) or febuxostat (40-80mg daily), while pseudogout management focuses on treating acute flares with colchicine, NSAIDs, or corticosteroids without specific crystal-preventing medications.
Some key points to consider:
- Gout and pseudogout are both forms of arthritis, but they have different underlying causes and affected joints 1.
- The treatment of gout and pseudogout also differs, with gout often requiring urate-lowering therapy and pseudogout typically being managed with anti-inflammatory medications 2.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute gout, and may also be used to manage pseudogout 3, 4.
- The choice of treatment should be based on the individual patient's needs and medical history, and may involve a combination of medications and lifestyle changes 5.
In terms of the most recent and highest quality evidence, a 2021 study published in The Cochrane database of systematic reviews found that NSAIDs are effective in treating acute gout, but may have adverse effects such as gastrointestinal problems 3. Another study published in 2018 in Primary care found that gout and pseudogout are both common conditions that can be effectively managed with appropriate treatment 2.
Overall, the key to managing gout and pseudogout is to accurately diagnose the condition and develop an effective treatment plan. This may involve a combination of medications, lifestyle changes, and regular monitoring to prevent complications and improve quality of life.