Joints in the Hand Affected by Gout
In the hand, gout primarily affects the metacarpophalangeal joints (MCPJs), particularly of the index and middle fingers, and may superimpose on pre-existing hand osteoarthritis. 1
Primary Joints Affected by Gout in the Hand
- Metacarpophalangeal joints (MCPJs) are the most commonly affected joints in the hand, with particular involvement of the index and middle fingers 1
- Wrist joints are also frequently affected by gout 1
- Gout can superimpose on pre-existing hand osteoarthritis, complicating the clinical picture 1
Distinguishing Features of Gouty Involvement in Hand Joints
- Unlike rheumatoid arthritis which primarily affects MCPJs, proximal interphalangeal joints (PIPJs), and wrists, gout has a more specific predilection for MCPJs and wrists 1
- While distal interphalangeal joints (DIPJs) and proximal interphalangeal joints (PIPJs) are more typically affected by osteoarthritis, these joints can occasionally be involved in gout, especially when superimposed on existing osteoarthritis 1
- Interphalangeal joint involvement in gout is less common but has been reported, particularly in tophaceous gout 2, 3
Diagnostic Considerations
- Radiography should be the initial imaging method for suspected gout in the hand, as imaging findings are often characteristic 1
- Both ultrasound and CT (especially dual-energy CT) complement radiography in detecting erosions and tophi in hand joints 1
- Dual-energy CT has been shown to detect monosodium urate deposition with a sensitivity of 87% and specificity of 84%, outperforming clinical assessment in gout diagnosis 1
- Definitive diagnosis requires joint aspiration with demonstration of birefringent monosodium urate crystals in the synovial fluid under polarized light microscopy 4, 5
Clinical Presentation of Gout in Hand Joints
- Acute gouty arthritis in the hand typically presents as sudden monoarthritis with intense pain and inflammation 5
- Affected joints become hot, swollen, erythematous, and exquisitely tender 3
- In chronic tophaceous gout, tophi (solid monosodium urate crystal aggregates) may develop over the interphalangeal joints 5
- Functional impairment can be significant, affecting quality of life and requiring prompt treatment 5
Differential Diagnosis
- Hand osteoarthritis primarily affects DIPJs, PIPJs, thumb base, and index and middle MCPJs 1
- Rheumatoid arthritis mainly targets MCPJs, PIPJs, and wrists 1
- Psoriatic arthritis may target DIPJs or affect just one ray 1
- Haemochromatosis mainly targets MCPJs and wrists, similar to gout 1
When evaluating hand joint pain, it's important to recognize that gout has a specific pattern of joint involvement that can help distinguish it from other arthritides, with MCPJs of the index and middle fingers being particularly characteristic targets.