Wrist gout. It can be difficult to diagnose

This page about wrist gout, page 2, was last reviewed, or updated, on 3 November 2015.

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A gout wrist could be difficult to diagnose 

It may take time before you confirm   that this is gout, and not one of the many other afflictions that can affect the wrist. (See gout wrist page 1) The best test for a diagnosis of gout is whether the needle-shaped MSU gout crystals can be seen under the lens of a polarising (polarizing) microscope. The test – called joint aspiration or arthrocentesis
  – requires removing synovial fluid out of the affected joint.

However, in some joints it’s difficult for the doctor to get enough synovial fluid out of the gouty area, to examine for the presence of gout crystals. Unfortunately, the wrist is one such type of joints because of all those small bones. If another joint is also inflamed, that one can be searched in the same way for MSU crystals. The best wrist joint for getting fluid is said to be the forearm radius joint adjacent to some of the wrist’s carpal bones - the radiocarpal joint.

Your rheumatologist, or other doctor, might be able to do it, s/he might not. A rheumatologist who has the necessary polarising (polarizing) microscope on the premises, which s/he often uses, is best.

If this way of diagnosing  gout isn’t possible, a judgement has to be made of how many of all the other distinguishing marks of gout your medical history and your wrist have.

Here  are the major hallmarks of gout - compare them with your wrist’s condition and your medical history.

Wrist questions

•    Most important – have you had a wrist gout attack, or gout attack elsewhere, before?

•    Has the affected wrist been injured before? Sprains, broken wrists – gout often goes for places that have been injured.

•    Is the wrist red, swollen, sore and very painful?

Other questions

•    Although the pain and inflammation may continue for weeks, did the size of the inflammation peak after 12-24 hours?

•    Was the attack accompanied by a fever? In gout (and pseudo gout) it may be.

•    Is your uric acid level (UA) above normal? This is NOT conclusive of gout, merely indicative, because most people with an above normal UA level never have a gout attack, and people with normal UA may get one. The UA level should be taken after the gout attack because if it is taken during a gout attack it will probably be lower than usual.

•    Are you are heavy drinker?

•    Are your kidneys functioning normally? Mal-performing kidneys raise blood uric acid levels, a precursor of a gout flare.

•    Has a family member, past and present, had gout?

    Do you have the classic conditions of the metabolic syndrome - obesity, high blood sugar, hyperlipidemia (hyperlipidaemia) - elevated blood fats such as triglycerides and cholesterol - and insulin resistance?

    What other meds are you taking? For example are you taking one of the thiazide diuretic class of drugs for high blood pressure? They raise uric acid levels, and can therefore trigger gout.

•    Did the attack begin during the night? Gout attacks –anywhere - frequently do.

•    Have you splurged on high purine dishes ?

What can you do about wrist gout pain?

Epsom salts Some report relief from Epsom salts and it's worth finding out if they give you some help, and when during a wrist gout attack. Leave your arm and and in a bowl of warm water with the salts , and read the newspaper or watch TV ! There's more information about using Epsom salts on our ankle gout page.

Cabbage leaves Wrapping your wrist(s) in chilled cabbage leaves may seem like a whacky, oddball method but there is a rational behind it. Read more on our gout foot pain page

Ice  Icing the wrist may also bring relief, but it might also encourage more crystal deposition since crystal deposition is very likely to be promoted by the cold. So if ice gives you some relief, stop it as soon as you think you’ve got the most relief you’re going to get.

A survey a few years ago showed that more gout sufferers thought they could get relief from ice, than those who thought they could get it from heat.

Medicines There are no specific conventional gout medicine treatments for gout of the wrist. For pain you will be given an NSAID, such as indomethacin or voltaren and perhaps colchicine to halt an attack. If they fail to work – corticosteroids.

As with gout in any part of the body , the long term aim of all types of treatment is to lower the serum (blood) uric acid level to below the level at which gout crystals dissolve and tophi shrinks, wherever they are located. This level is thought to be below 6.0 mg/dL (men) and around 5.5 mg/dL (women), but precisely it is a personal matter between you and your gout. You may need to go lower.

With medications, lowering uric acid to these levels and dissolving crystals can occur within six months to two years for most people, especially if you are healthy in other respects. But you will be on guard against gout for the rest of your life. With natural remedies you may be able to lower uric acid sufficiently too, and stave off impending gout attacks with them. You can find details of the drugs and the natural gout remedies on the rest of this website.

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Related pages

Big toe gout is a big gout issue 

Read why finger gout may be one of the worst kinds of gout you can get. 

Elbow gout is different to gout in other body areas. Read why and how here. 

Read about features of gout foot pain, including a home remedy that might help.

Knee gout is about more than knobbly knees.

Read what it's like when gout attacks the ears. 

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