Improved Management of Hand and Wrist Gout
This article offers a review of the epidemiology, pathology, and signs and symptoms of gout. Epidemiology refers to patient characteristics such as age, gender, and incidence of a disease or condition. Management of hand and wrist gout (a more uncommon form of gout) is also included.

It appears that the number of cases of gout may be increasing. This is thought to be related to the fact that people are living longer. As we age, cartilage and synovium degenerate. This leaves the joints more susceptible to gout because of these arthritic changes.

Improved medical management may help offset chronic symptoms and damage from this condition. A team of specialists is helpful in getting the best results. The physician provides supervised drug therapy and focuses on preventing complications of the disease.

The physical therapist teaches the patient how to prevent loss of motion and function, especially during flare-ups. Splinting, exercises, and other rehab tools may be used. Nutrition, diet, and education about lifestyle factors are important parts of the management program.

For example, there is a known link between alcohol and gout. Patients are advised to limit alcohol intake, especially beer but also liquor. Drinking small amounts of wine does not seem to increase the risk.

Certain food can also increase the uric levels associated with gout and should be avoided. These include meat and seafood. Dairy products and purine-rich vegetables such as peas, spinach, and cauliflower help reduce the risk of gouty attacks.

The wrist and hand are sites of gout in older adults. Postmenopausal women taking diuretics (water pills) seem to be affected most often. Tophus deposits along tendons of the wrist, hand, and finger tendons may require surgical treatment.

Tophus (tophi is plural) is the deposit of crystallized monosodium urate. A pocket of these crystals can put pressure on the nerves and cause painful inflammation of the joints. Surgery to remove the tophi and wash out the crystals may help improve tendon gliding.

In some cases, part of the tendon may have to be removed. The surgeon does everything possible to avoid this step. If it is necessary, then tendon grafting, tendon transfers, and joint fusion may be required. Amputation of the finger is considered only when uncontrolled pain and infection prevents healing.

The authors say that gout of the wrist and hand is relatively uncommon. Advanced cases can cause severe loss of hand function. Today's improved management has resulted in better outcomes for patients affected by this disease.
Brian T. Fitzgerald, MD, et al. Gout Affecting the Hand and Wrist. In Journal of the American Academy of Orthopaedic Surgeons. October 2007. Vol. 15. No. 10. Pp. 625-635.