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

Gout stands as a distinct form of inflammatory arthritis, characterized by its sudden onset and excruciating pain. This condition arises from elevated levels of uric acid in the body, a state medically known as hyperuricemia. While typically recognized for its propensity to affect the big toe, gout can manifest in various other joints, including the thumb. The presence of burning pain within a thumb joint could indeed signal a gout attack, also referred to as a flare or flare-up, demanding prompt attention and understanding.

Although gout in the thumb is considered less common, it can significantly impact an individual's daily life due to the thumb's critical role in countless everyday actions. The condition might target either the carpometacarpal (CMC) joint, which forms the crucial connection between the thumb and the wrist, or the metacarpophalangeal (MCP) joint, the larger joint in the hand where the thumb bone meets the hand bones. Both joints are vital for the thumb's intricate movements and functions.

The pain associated with a gout attack in the thumb can be exceptionally severe, largely because of the thumb's constant use in activities ranging from turning a doorknob to writing or grasping objects. This intense discomfort stems from active inflammation within the affected joint. Inflammation is the body's natural response to irritation or injury, manifesting as noticeable swelling, marked tenderness, distinct redness, and a sensation of warmth in the inflamed thumb area. Understanding these symptoms is the first step toward effective management.

eyepark / Getty Images

What Causes Gout in the Thumb?

The primary cause of gout is hyperuricemia, a condition where the body accumulates excessive amounts of uric acid. Under normal physiological conditions, the kidneys efficiently filter uric acid from the bloodstream, expelling it through urine. However, when the production of uric acid overwhelms the kidneys' capacity to excrete it, or when kidney function is impaired, uric acid levels in the blood rise. This excess uric acid can then migrate from the bloodstream into joint spaces, where it crystallizes, forming sharp, needle-like urate crystals.

When these urate crystals deposit within a joint, the body's immune system perceives them as foreign invaders, triggering a robust inflammatory response. This immune reaction is responsible for the characteristic and often debilitating symptoms of a gout attack. The affected joint rapidly becomes swollen, intensely painful, and tender to the touch. Furthermore, the skin over the joint often appears red and feels warm, indicating the active inflammatory process underway. Recognizing these signs is crucial for early diagnosis and intervention.

Several factors are known to increase an individual's susceptibility to developing gout. These risk factors can be broadly categorized into genetic predispositions, specific medication usage, coexisting health conditions, previous injuries, dietary habits, and demographic elements such as age and sex. A comprehensive understanding of these contributing factors is essential for both prevention and effective management strategies, helping to identify individuals at higher risk and guiding lifestyle adjustments.

Genes and Family History

A significant factor influencing the risk of gout is an individual's genetic makeup and family history. If the condition has affected close relatives, such as a parent or sibling, your own likelihood of developing gout is considerably elevated. Research indicates that the heritability of hyperuricemia, the precursor to gout, ranges between 45% and 73%, underscoring the strong genetic component. This suggests that certain genetic variants can predispose individuals to impaired uric acid metabolism or excretion, making them more prone to crystal formation and subsequent gout attacks.

Family history plays a crucial role not only in the predisposition to hyperuricemia but also in the manifestation of gout itself. Individuals with a first-degree relative diagnosed with gout are at a demonstrably higher risk. This genetic link highlights the importance of discussing family medical history with healthcare providers, particularly if symptoms suggestive of gout emerge. Understanding these genetic influences allows for proactive monitoring and early intervention strategies, potentially mitigating the severity or frequency of future gout flares.

Medications

Certain medications can inadvertently increase uric acid levels in the bloodstream, thereby elevating the risk of developing gout. Diuretics, commonly known as "water pills" and frequently prescribed for conditions like high blood pressure or fluid retention, are a notable example. They can reduce the kidneys' ability to excrete uric acid, leading to its accumulation. Similarly, beta-blockers, another class of drugs used to treat hypertension and various heart conditions, have been associated with increased uric acid levels.

Cyclosporine, an immunosuppressant medication often used in organ transplant recipients to prevent rejection, is also known to raise uric acid levels, increasing gout risk in these patients. Even commonly available medications like aspirin, particularly in low doses, can interfere with uric acid excretion by the kidneys. It is crucial for individuals on these medications to be aware of the potential for elevated uric acid and discuss any concerns with their healthcare provider, especially if they experience symptoms indicative of gout.

Underlying Health Conditions

A number of pre-existing health conditions can significantly contribute to elevated uric acid levels in the bloodstream, consequently increasing the risk of gout. High blood pressure, or hypertension, is a common comorbidity found in individuals with gout. The relationship between hypertension and hyperuricemia is complex, often involving shared metabolic pathways that can impair the kidneys' ability to process uric acid efficiently, leading to its buildup.

Kidney diseases, whether acute or chronic, present a particularly heightened risk for gout. The kidneys are central to the body's uric acid excretion process; thus, any impairment in their function directly hinders the elimination of uric acid, causing it to accumulate. Diabetes, another prevalent chronic condition, is also linked to an increased risk of gout. Insulin resistance and metabolic dysfunction associated with diabetes can interfere with uric acid metabolism, making individuals with diabetes more susceptible to hyperuricemia and subsequent gout attacks.

Hand Injuries

For individuals who experience recurrent gout attacks, avoiding injuries to the fingers or thumb becomes a critical preventive measure. A direct injury to the thumb can trigger localized inflammation and disrupt the delicate balance of uric acid within the joint space. This localized trauma can lead to a concentrated buildup of uric acid crystals within the thumb joints, even if systemic uric acid levels are not acutely high at the time of injury. The inflammatory cascade initiated by the injury itself can provide a conducive environment for crystal formation and precipitation.

Consequently, a seemingly minor thumb injury has the potential to precipitate a gout flare-up in the affected digit. Similarly, injuries to other fingers can also provoke a localized gout attack. This highlights the importance of protecting the hands and thumbs, especially for those with a known predisposition to gout or a history of previous flares. Implementing protective measures and being mindful of potential trauma can play a significant role in preventing the onset of painful gout episodes in these vulnerable joints.

Diet

Dietary choices play a substantial role in influencing uric acid levels in the body, with a diet rich in purines being a primary contributor to hyperuricemia and, subsequently, gout. Purines are natural compounds found in many foods, and when metabolized by the body, they produce uric acid. While the body produces some purines internally, external sources from food can significantly augment the overall purine load.

Foods notoriously high in purines include red meat, organ meats like liver and kidney, and certain types of seafood such as anchovies, sardines, herring, and scallops. Alcoholic beverages, particularly beer, are also significant sources of purines, as are sugary drinks, including soft drinks and fruit juices, which contain fructose that can increase uric acid production. Additionally, studies consistently indicate a strong correlation between being overweight or obese and an elevated risk of gout. Conversely, achieving and maintaining a healthy weight through dietary modifications and exercise can substantially lower uric acid levels and reduce the frequency and severity of gout attacks. Weight loss also concurrently reduces the mechanical stress on weight-bearing joints, offering a dual benefit.

Age and Sex

Demographic factors such as age and sex significantly influence an individual's risk of developing gout. Historically, gout has been more prevalent in people assigned male at birth, primarily because they typically exhibit higher baseline uric acid levels compared to those assigned female at birth. This disparity is largely attributed to hormonal differences, particularly the protective effect of estrogen in premenopausal women, which tends to promote uric acid excretion.

However, this gender difference tends to diminish with age. Following menopause, when estrogen levels decline, uric acid levels in individuals assigned female at birth tend to rise, making them more susceptible to gout. Consequently, people assigned male at birth often experience the onset of gout earlier in life, typically before the age of 50. In contrast, those assigned female at birth commonly develop gout after the menopausal transition, often mirroring the prevalence rates seen in men of similar age groups.

How Common Is Gout in the Thumb?

While gout is a widespread form of arthritis, affecting millions of Americans, its occurrence in the thumb is considered relatively uncommon compared to other joints. A comprehensive study published in Arthritis & Rheumatology in 2019 revealed that nearly 10 million individuals in the United States live with gout. Despite this high prevalence, the deposition of urate crystals and the subsequent inflammation most frequently target the big toe, making it the hallmark location for a gout flare.

Beyond the big toe, other joints are more commonly affected by gout. These typically include the knee, elbow, wrist, and various finger joints. While the thumb can indeed be a site for urate crystal formation and a gout attack, it is statistically less frequent than in these other locations. This rarity can sometimes lead to misdiagnosis or delayed recognition of gout when it presents in the thumb, emphasizing the importance of thorough evaluation by a healthcare provider.

Is Your Thumb Pain Due to Gout or Something Else?

While gout attacks are renowned for causing intense, often unbearable pain, making them difficult to overlook, it is important to recognize that thumb pain can stem from various other conditions. Gout is not the sole cause of discomfort in the thumb, and other types of arthritis or injuries might also present with similar symptoms. Differentiating gout from these alternative conditions is crucial for accurate diagnosis and appropriate treatment.

The thumb is a complex joint frequently used in daily activities, making it susceptible to various musculoskeletal issues. Conditions such as rheumatoid arthritis, psoriatic arthritis, pseudogout, direct injury or infection, and osteoarthritis are all more commonly associated with thumb pain than gout. A thorough medical evaluation, including a detailed symptom history and diagnostic tests, is often necessary to pinpoint the precise cause of thumb discomfort and ensure effective management.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease where the immune system mistakenly attacks the body's own healthy tissues, primarily targeting the synovial linings of the joints. This systemic inflammation leads to pain, swelling, stiffness, and eventually joint damage. The joints of the hands, including the fingers and thumbs, are particularly susceptible to RA, making it a common cause of thumb pain.

In the thumb, RA frequently affects both the carpometacarpal (CMC) and metacarpophalangeal (MCP) joints, similar to gout. However, RA symptoms often develop more gradually and typically affect multiple joints symmetrically, unlike the acute, often singular joint involvement seen in a gout flare. The severe pain and swelling caused by RA in the thumb can significantly impair daily tasks, especially those requiring fine motor skills like grasping, gripping, writing, or holding common objects.

Psoriatic Arthritis

Psoriatic arthritis (PsA) is another form of autoimmune arthritis closely associated with psoriasis, an autoimmune skin condition characterized by red, scaly patches. Like rheumatoid arthritis, PsA involves the immune system attacking healthy joint tissues. When PsA affects the hands, it can lead to noticeable swelling and stiffness in the hand and finger joints, presenting a challenge in differentiating it from gout.

A distinctive feature of PsA in the thumb is its predilection for causing inflammation at the interphalangeal (IP) joint. This is the first joint of the thumb, located near the tip and just below the fingernail. PsA can also cause "sausage digits" (dactylitis), where an entire finger or thumb swells uniformly. While both gout and PsA involve inflammation and swelling, the specific pattern of joint involvement and the presence of skin psoriasis can help distinguish PsA from a gout flare.

Pseudogout

Pseudogout is an inflammatory arthritic condition that often mimics the symptoms of gout, leading to its name. However, unlike gout, which is caused by uric acid crystals, pseudogout develops when calcium pyrophosphate crystals deposit within joints and soft tissues. These crystals trigger an inflammatory response similar to that seen in gout, causing acute pain, swelling, and redness. Pseudogout commonly affects larger joints like the knee, but it can also frequently involve the wrists and hands, making it a consideration for thumb pain.

Distinguishing between gout and pseudogout is medically essential, as their respective treatments differ significantly. A healthcare provider can definitively differentiate between these two conditions by performing a joint fluid aspiration, a procedure where a small sample of fluid is drawn from the affected thumb joint. This fluid is then analyzed under a microscope to identify the specific type of crystals present—urate crystals for gout or calcium pyrophosphate crystals for pseudogout—ensuring an accurate diagnosis and targeted treatment plan.

Injury or Infection

Thumb pain and swelling are not exclusively indicative of arthritic conditions; they can also be a direct result of an injury or an infection. A direct trauma to the thumb, such as a sprain, fracture, or dislocation, can cause immediate pain, swelling, and bruising, depending on the severity of the damage to the bones, ligaments, or tendons. Any significant impact or awkward movement can lead to such injuries, affecting the thumb's mobility and strength.

Furthermore, a swollen thumb can also be a symptom of a bacterial nail infection, known as paronychia, which affects the skin around the fingernail or thumbnail. This type of infection can cause localized pain, redness, warmth, and significant swelling around the digit. While an infection might present with inflammatory signs similar to gout, the presence of pus, a visible entry point for bacteria, or a history of recent minor trauma to the nail area can help differentiate it from an arthritic flare.

Osteoarthritis

Osteoarthritis (OA) is the most prevalent form of arthritis affecting the thumb, particularly at the base of the thumb in the carpometacarpal (CMC) joint. Unlike gout, which is an inflammatory condition driven by crystal deposition, OA is primarily a degenerative joint disease characterized by the gradual breakdown of cartilage over time. This "wear and tear" process leads to the loss of cartilage, the smooth, cushioning material that allows bones to glide effortlessly against each other.

As cartilage erodes in OA, bones begin to rub directly against each other, causing chronic pain, stiffness, and reduced range of motion. The symptoms of thumb OA typically progress slowly over months or years, often exacerbated by activity, whereas gout flares are usually sudden and intense. While OA can cause joint swelling, it's generally less pronounced and lacks the intense redness and heat seen in an acute gout attack. Recognizing these distinct characteristics is crucial for accurate diagnosis.

Combination of Conditions

It is important to understand that gout, along with other conditions causing joint pain, particularly in the thumb, can occasionally coexist in the same individual. This phenomenon can complicate diagnosis, as symptoms might overlap or be attributed to the more obvious condition. For instance, a 2019 study revealed that up to 6% of individuals diagnosed with rheumatoid arthritis (RA) also had coexisting gout, suggesting a higher likelihood of both conditions appearing together than by chance.

Similarly, gout has been observed to coexist with psoriatic arthritis (PsA) and osteoarthritis (OA). This coexistence implies that having one type of arthritis might, in some cases, increase the risk for another, or that shared risk factors contribute to their development. Given the potential for overlapping symptoms, distinguishing which specific arthritic condition is primarily responsible for thumb pain based solely on symptoms can be challenging. Therefore, a comprehensive medical evaluation involving various tests, including imaging, blood work, and joint fluid aspiration, becomes essential to accurately determine the underlying cause and guide appropriate management.

A Telltale Sign of Gout in the Thumb: Tophi

Tophi are a distinctive and often telltale sign of advanced or chronic gout. These are large, hardened masses that form when uric acid crystals accumulate extensively within and around joints, as well as in other soft tissues. The presence of tophi is indicative of prolonged and often poorly controlled hyperuricemia, where the body's uric acid levels have remained elevated for an extended period, leading to significant crystal deposition.

The formation of tophi can lead to several complications. They can cause chronic pain, contribute to noticeable joint deformity, and severely limit the range of motion in the affected joint, impacting daily function. While tophi can develop in any joint, they are particularly problematic when they affect the small, intricate joints of the fingers and thumbs. In these areas, tophi can lead to significant physical changes, impairing dexterity and causing considerable discomfort. Furthermore, advanced tophi can sometimes lead to joint damage or even become infected, necessitating careful medical attention and potentially surgical intervention.

How Providers Diagnose Gout in the Thumb

A gout attack, whether it occurs in the thumb or another joint, is typically characterized by its acute and severe nature, often lasting up to 10 days if left untreated. However, seeking prompt medical attention can significantly shorten the recovery period and mitigate the severity of symptoms. If you suspect you are experiencing a gout flare-up, especially with intense pain and swelling in your thumb, it is highly advisable to consult a healthcare provider without delay for an accurate diagnosis.

During your visit, the healthcare provider will typically begin with a thorough physical examination of your thumb, carefully inspecting for any visible lumps, swelling, redness, or warmth that might suggest the presence of tophi or acute inflammation. This will be followed by a detailed discussion of your symptoms. You will be asked about the onset of pain, its characteristics, duration, and whether this is your first gout flare-up. Furthermore, the provider will inquire about any underlying health conditions, current medications you are taking, and any family history of gout or other arthritic conditions, as these factors are crucial for a comprehensive assessment.

If gout is suspected, or if the cause of your symptoms remains unclear after the initial examination, the healthcare provider will likely request additional diagnostic tests. These tests are essential for confirming a gout diagnosis and ruling out other conditions that might mimic its symptoms.

One of the primary diagnostic tools is a blood test to measure your body's uric acid levels. While elevated uric acid levels (hyperuricemia) are a hallmark of gout, it is important to note that high uric acid does not automatically confirm gout, nor do normal levels during an acute flare necessarily rule it out. Some individuals with high uric acid never develop gout symptoms, and conversely, uric acid levels can temporarily drop during an acute attack, leading to a false negative.

The joint fluid test, also known as joint aspiration or arthrocentesis, is considered the gold standard for diagnosing gout. This procedure involves carefully drawing a small sample of fluid from the painful joint using a thin needle. The collected fluid is then sent to a laboratory where it is examined under a microscope. The definitive presence of urate crystals within the joint fluid confirms a diagnosis of gout, providing clear evidence of the underlying cause of the inflammation.

Imaging studies can also play a supportive role in diagnosing gout and differentiating it from other conditions. X-rays, for instance, can help rule out other forms of arthritis, such as osteoarthritis or rheumatoid arthritis, by revealing characteristic patterns of bone erosion or joint space narrowing. An ultrasound examination is particularly useful as it can directly visualize uric acid deposits within the affected joint, even before they form visible tophi. This non-invasive imaging technique provides valuable insights into the presence and extent of crystal deposition.

Treatment for Gout in the Thumb

Treatment for an acute gout flare of the thumb typically focuses on rapidly reducing the intense inflammation and managing the accompanying pain. The goal is to alleviate discomfort and allow the joint to recover.

Several medication options are available for managing an acute flare:

Nonsteroidal anti-inflammatory drugs (NSAIDs), available over-the-counter or by prescription, are often the first-line treatment. These medications, such as ibuprofen or naproxen, work by inhibiting inflammatory pathways in the body, thereby easing pain and bringing down swelling in the affected thumb. For severe flares, a higher dose or prescription-strength NSAID might be prescribed.

Corticosteroids are potent anti-inflammatory medications that can be prescribed for short periods to manage acute gout flares, especially if NSAIDs are contraindicated or ineffective. They work by suppressing the immune system's inflammatory response, providing rapid relief from pain and swelling. Corticosteroids can be administered orally or directly injected into the affected joint for localized relief.

Colchicine is another specific medication used for gout. It can be given orally to treat an acute gout attack, particularly if initiated within the first 24 hours of symptom onset, helping to reduce inflammation and pain. Furthermore, colchicine is also used at lower daily doses to prevent future flares in individuals with recurrent gout.

If you experience recurrent gout flare-ups, your healthcare provider will likely recommend additional treatments aimed at preventing gout from becoming chronic and leading to complications like tophi. These medications are designed to lower uric acid levels in the long term.

Aloprim or Zyloprim (allopurinol) is a widely prescribed medication that works by reducing the production of uric acid in the body. It is an enzyme inhibitor that prevents the conversion of purines into uric acid, thereby maintaining lower uric acid levels and preventing crystal formation.

Uloric (febuxostat) operates similarly to allopurinol by reducing uric acid formation from purines. It is an alternative option for individuals who cannot tolerate or do not respond adequately to allopurinol.

Probalan (probenecid) works differently, by assisting the kidneys in filtering and excreting more uric acid through the urine. This helps to reduce the overall uric acid burden in the bloodstream.

Krystexxa (pegloticase) is an intravenous (IV) drug reserved for severe, chronic gout that has not responded to other therapies. It functions by actively breaking down urate crystals already present in the body, helping to dissolve tophi and lower uric acid levels dramatically.

Surgery is generally considered a last resort for gout-affected joints and is rarely needed. It is typically recommended only in specific situations where there is significant and irreversible thumb joint damage, nerve compression caused by large tophi, or in cases where tophi have become severely infected. The primary goal of surgery in these instances is to alleviate pressure, repair joint structures, or remove infected material, not to treat the gout itself, which is managed medically.

Lifestyle and Self-Care

Beyond medical interventions, incorporating certain lifestyle modifications and self-care measures can significantly contribute to managing gout symptoms and preventing future flares. These strategies empower individuals to take an active role in their condition.

A critical aspect of managing gout involves dietary adjustments. Individuals with gout should consciously avoid foods and beverages known to be high in purines, as these contribute directly to elevated uric acid levels. Such items include alcoholic beverages, especially beer, and sugary drinks, including soft drinks and juices high in fructose. Certain fish and shellfish, like anchovies, sardines, herring, scallops, trout, crab, and lobster, are also high in purines and should be limited. Processed meats, such as hot dogs and luncheon meats, organ meats (kidney and liver), and fatty meats like beef, pork, and duck, are also significant sources of purines.

In addition to careful dietary management, maintaining adequate hydration is crucial. Drinking plenty of water throughout the day can help the kidneys flush out uric acid more effectively, potentially reducing its concentration in the bloodstream and shortening recovery time during a flare. Applying ice packs or cold compresses to the affected thumb can offer immediate relief from pain and swelling during an acute attack. Ice can be applied for up to 20 minutes at a time, several times a day, to help constrict blood vessels and reduce inflammation. Lastly, it is advisable to avoid using the affected thumb during a gout flare to minimize irritation and promote healing. Your healthcare provider might also suggest using a splint or brace to immobilize the thumb, providing rest and support, which can further aid in managing your thumb gout symptoms and promoting recovery.

Summary

Gout is a distinct form of arthritis resulting from the deposition of uric acid crystals within a joint, leading to acute inflammation and severe pain. Several factors heighten the risk of developing gout, including a family history of the condition, increasing age, biological sex (with individuals assigned male at birth generally having a higher risk before menopause), certain underlying medical conditions such as kidney disease and hypertension, specific medications, and a diet rich in purines.

While the big toe is the most common site for gout flares, a thumb injury could trigger a localized accumulation of uric acid crystals in one of the thumb joints. If systemic uric acid levels are not adequately managed, this could precipitate a painful gout flare-up in the thumb. Due to the thumb's constant use in daily activities, a gout attack in this joint can be particularly debilitating.

It is crucial to seek medical attention if you experience sudden, severe swelling and pain in your thumb, especially if you have a pre-existing gout diagnosis or are at high risk for the condition. Timely diagnosis and treatment are essential to reduce the intensity and duration of symptoms, prevent future attacks, and mitigate the progression to chronic gout and the formation of tophi, which can cause significant joint damage. Fortunately, surgical intervention is rarely required for gout-affected joints; however, it may become necessary in advanced cases where severe joint damage or tophi-related complications occur.

Read more:

• Health A-Z
• Arthritis
• Gout

20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Ian Jason M, Muramatsu K, Tani Y, Kobayashi M. Atypical erosive tophaceous gout with severe osteolysis around multiple joints of the digits: A case report. J. Orthop. Res. 2022;1(4):100101. doi:10.1016/j.jorep.2022.100101
2. Dalbeth N, Stamp LK, Merriman TR. The genetics of gout: towards personalised medicine? BMC Med. 2017;15(1):108. doi:10.1186/s12916-017-0878-5
3. Helget LN, Mikuls TR. Environmental triggers of hyperuricemia and gout. Rheum Dis Clin North Am. 2022;48(4):891-906. doi:10.1016/j.rdc.2022.06.009
4. MacFarlane LA, Kim SC. Gout: a review of non-modifiable and modifiable risk factors. Rheum Dis Clin North Am. 2014;40(4):581-604. doi:10.1016/j.rdc.2014.07.002
5. Ou SH, Chou CL, Lin CW, et al. Association between gout and injury risk: a national retrospective cohort study. Int J Environ Res Public Health. 2020;17(10):3679. doi:10.3390/ijerph17103679
6. Zhang Y, Chen S, Yuan M, Xu Y, Xu H. Gout and diet: a comprehensive review of mechanisms and management. Nutrients. 2022;14(17):3525. doi:10.3390/nu14173525
7. Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: the National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019;71(6):991-999. doi:10.1002/art.40807
8. American Academy of Orthopaedic Surgeons. Gout.
9. Boeckstyns, M.E.H. (2016). The rheumatoid thumb. In: Chung, K. (eds) Clinical Management of the Rheumatoid Hand, Wrist, and Elbow. Springer, Cham. doi:10.1007/978-3-319-26660-2_21
10. Mathew AJ, Ganapati A, Panwar J, Koshy V, Desai A, Danda D. Magnetic resonance imaging evidence of inflammation at interphalangeal joint of thumb - a distinct entity in psoriatic arthritis. Int J Rheum Dis. 2021;24(12):1467-1472. doi:10.1111/1756-185X.14156
11. American Society for Surgery of the Hand. Pseudogout.
12. Nemour KidsHealth. Paronychia.
13. Hospital for Special Surgery. Basal joint arthritis: osteoarthritis of the thumb.
14. Chiou A, England BR, Sayles H, et al. Coexistent hyperuricemia and gout in rheumatoid arthritis: Associations withcomorbidities, disease activity, and mortality. Arthritis Care Res (Hoboken). 2020;72(7):950-958. doi:10.1002/acr.23926
15. Felten R, Duret PM, Gottenberg JE, Spielmann L, Messer L. At the crossroads of gout and psoriatic arthritis: "psout.” Clin Rheumatol. 2020;39(5):1405-1413. doi:10.1007/s10067-020-04981-0
16. Chen D, Xu H, Sun L, Li Y, Wang T, Li Y. Assessing causality between osteoarthritis with urate levels and gout: a bidirectional Mendelian randomization study. Osteoarthritis Cartilage. 2022;30(4):551-558. doi:10.1016/j.joca.2021.12.001
17. Hospital for Special Surgery. The 4 stages of gout progression (and how to stop gout from getting worse).
18. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout: diagnosis, treatment, and steps to take.
19. Dakkak M, Lanney H. Management of gout: update from the American College of Rheumatology. Am Fam Physician. 2021;104(2):209-210.
20. Słowińska I, Słowiński R, Rutkowska-Sak L. Tophi - surgical treatment. Reumatologia. 2016;54(5):267-272. doi:10.5114/reum.2016.63819