Gout in Wrist: Symptoms, Diagnosis, Treatment - Verywell Health
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Gout is a type of inflammatory arthritis. It generally affects one joint at a time—often the big toe. People who live with gout experience periods known as flares, times when symptoms worsen, as well as times of remission, during which there are no symptoms. Gout flares are sometimes called gout attacks.
Gout can affect any joint, including the wrist, but having wrist gout is rare, especially on its own. Having gout in more than one joint is called polyarticular gout. People who experience gout in the wrist will find their affected wrist suddenly painful and swollen. Fortunately, gout in the wrist is manageable and treatable.
This article will cover the signs and symptoms of gout in the wrist, its causes, diagnosis, and treatment.
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Signs and Symptoms of Gout in the Wrist
Gout in the wrist is not as common as gout in the big toe. This makes it harder for healthcare providers to diagnose.
If you experience gout in your wrist, symptoms will come on quickly and become severe. In people with gout of the wrist, often only one of their wrists is affected, but both wrists can be. It is also possible for gout to affect the hand and wrist simultaneously.
According to a 2018 study reported in the journal European Radiology, clinical symptoms of wrist or hand gout might include:
- Swelling of the wrist or hand, or both
- Hotness, redness, and/or tenderness of affected joints
- Symptoms lasting one to four weeks
Additional symptoms of gout in the wrist might include:
- Wrist joint stiffness
- Restricted movement due to pain and swelling
- Excruciating pain
- Fever as a result of ongoing inflammation
- Headache
- Malaise: A general feeling of illness
- Gouty tophi: Tophi are chunks of uric acid that accumulate in and around joints. Tophi are common in people with long-standing or advanced gout.
- Kidney stones and renal troubles: Urate crystals can collect in the urinary tract of someone with gout, leading to kidney stones. Research has shown that people who experience early signs of tophi are more likely to develop renal dysfunction (kidney failure).
You should see a healthcare provider if you have wrist pain and swelling. Gout flares will worsen with repeated episodes. Untreated or severe gout can cause permanent joint damage and affect your ability to use affected joints. Therefore, it is vital to work with a healthcare provider to get gout symptoms and flares under control.
Causes of Gout
The cause of a gout flare is too much uric acid in the body. The body generally expels uric acid in the urine, but for some people, uric acid increases to abnormal levels. When this happens, the uric acid crystallizes in the affected joints.
With gout of the wrist, the crystals will build up in the wrist and its surrounding tendons. They will also accumulate in the synovial space (joint lining) of the wrist, causing pain and inflammation.
Gout is linked to specific risk factors—some of which are modifiable and others that are not.
Risk factors include:
- Overconsumption of alcohol
- Eating foods high in purines (chemical compounds naturally found in food that produce uric acid when they are digested) such as red meat, sweetened beverages, and seafood
- Family history
- Certain health conditions, including kidney disease, diabetes, and hypertension (chronic high blood pressure)
- Cancer medications
- Skin diseases like psoriasis (an inflammatory skin condition)
- Inflammatory arthritis conditions like rheumatoid arthritis and psoriatic arthritis
- Wrist trauma
- Chronic stress
- Being male: Males under age 65 have a 4 times higher risk of gout than females. That rate decreases to 3 times higher after age 65.
- Increasing age: The risk of gout for people of all sexes increases as they get older.
Diagnosis
Gout in the wrist is sometimes misdiagnosed because other conditions cause similar symptoms, including different types of inflammatory arthritis. Getting an early diagnosis and starting treatment as soon as possible are the best ways to avoid irreversible damage to your wrist.
Diagnosing gout of the wrist starts with an examination of the wrist. Your healthcare provider will check the affected wrist for tenderness, redness, warmth, and swelling. They will also ask about your family history of gout and other inflammatory diseases.
If your healthcare provider suspects you have gout, they will request additional testing to confirm the diagnosis.
Testing for gout includes:
- Uric acid blood test: High uric acid levels are linked to gout. While it is possible to have high uric acid levels and not have gout, this test is a starting point for determining the source of your symptoms.
- Joint aspiration: This test involves taking a sample of joint fluid from the affected wrist and examining it under a microscope to look for urate crystals.
- Imaging: X-rays can help detect joint damage and tophi under the skin. A dual-energy computed tomography (CT) scan can detect urate crystals in your affected wrist. While helpful, CT scans are rarely done due to their cost. Ultrasound can also detect urate crystals, and the price of testing might be more reasonable.
Your primary care provider will likely request testing and examine your affected wrist. After making a diagnosis, they will refer you to a rheumatologist, a doctor specializing in joint and connective tissue diseases.
A rheumatologist can provide you with more specialized care, especially if your gout is severe or you have experienced joint damage.
Treatment
According to the Centers for Disease Control and Prevention (CDC), the goals for treating gout in any affected joint are:
- To manage pain during flares
- To prevent future gout attacks
- To prevent tophi and kidney stones
Gout in the wrist typically is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), a targeted medicine called Colcrys (colchicine), and corticosteroids to manage flare-ups. Your healthcare provider might also recommend self-management strategies you can incorporate daily to help with symptoms and to keep flares at bay.
NSAIDs: NSAIDs, such as aspirin or Advil and Motrin (ibuprofen) can treat pain and inflammation. They are commonly given during a gout attack and are discontinued when symptoms are resolved.
Colchicine: Oral colchicine can be given to stop a gout attack.
Corticosteroid: A corticosteroid can be given as an injection or in pill form. These medicines can help to control pain and bring down inflammation.
If you are someone who experiences frequent gout attacks, your healthcare provider might prescribe medications to reduce the amount of uric acid in your body. For example, some medicines like Zyloprim (allopurinol) block uric acid production, whereas others like Probalan (probenecid) can help improve uric acid removal from the body.
Self-management techniques can help you to better manage gout symptoms, including:
- Eat a healthy diet: Avoid foods that might trigger a gout attack, especially those high in purines. Consider a diet of low-fat proteins and dairy and plenty of fruits and vegetables.
- Reduce your consumption or stop drinking alcohol: Alcohol can increase the risk of gout.
- Protect your joints: Joint injuries can make gout worse. Choose activities that are gentle on joints, including walking, swimming, and biking. These exercises are low impact and put little stress on the joints.
- Stay hydrated: Drink plenty of fluids, especially water, to help eliminate uric acid through urine.
- Rest and treat your wrist: During a gout attack of the wrist, you will want to prevent excessive strain, so avoid using the affected wrist. Apply an ice pack to reduce pain and bring down swelling.
Surgery is usually the last option for treating gout of the wrist. If gout has caused damage to your wrist or tendons, your healthcare provider might recommend surgical treatment to repair the wrist.
Summary
Gout in the wrist is rare, but it can be excruciating for people who experience it. Symptoms include wrist swelling, stiffness, restricted movement, and fever. Treatment for gout of the wrist consists of medications, self-management strategies, and surgery as a last result.
Talk to a healthcare provider if you experience gout symptoms or have wrist pain that doesn't go away with at-home treatment. Gout in the wrist can lead to permanent joint or tendon damage if left untreated.
A Word From Verywell
Most people with gout can live normal and productive lives if diagnosed early. But untreated wrist gout can lead to joint damage, severe pain, hand and wrist problems, kidney stones, and renal dysfunction.
Make sure you check in with your treating provider regularly and take steps to lower your uric acid levels. These are the best ways to ensure a positive outlook and reduce wrist pain and other joint problems.
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