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Demographic and Treatment Profile of Gout in the Upper Extremities
Vivek Muddana, None
1; Venkata Bodavula, MD
2(1)Hand Surgeon Community Practice, St. Peters, MO, (2)Venkata Bodavula MD, St. Petersburg, MO
Introduction Gout is a common metabolic disease affecting multiple joints in the body, yet its presentation in the upper extremities creates a diagnostic conundrum, frequently mimicking infection or trauma. Gout most commonly affects the lower extremities (80%), making its manifestation in the hand, wrist, and elbow a less common occurrence (9%). Due to this clinical ambiguity, gout presenting in the upper extremities is frequently misdiagnosed as an infection or trauma, leading to significant diagnostic delays, inappropriate antimicrobial therapy, and increased patient morbidity from prolonged inflammation and joint stiffness. To elucidate this challenging clinical picture, this study characterizes the demographic and treatment profiles of crystal-induced arthropathy in the largest case series.
Materials & MethodsA retrospective case series was conducted by reviewing 6,866 patient charts in a community hand surgery practice from January 1, 2018, to the present. The study comprised 121 patients who met the inclusion criterion of acute gout of the hand, wrist, or elbow. Data on patient demographics, diagnostics, clinical history, and treatment modalities were systematically extracted and analyzed.
Results The cohort of 121 patients (112 gout, 9 pseudogout) was predominantly male (65.3%) with a mean age of 71.5 years. A personal past history of gout was noted in 33% of patients, whereas a family history was present in only 12%. The overall distribution included 64 cases in the hand, 56 in the wrist, and 1 in the elbow. Within the hand, notable sites of involvement included the Proximal Interphalangeal (PIP) joints (n=68), Metacarpophalangeal (MCP) joints (n=30), and Distal Interphalangeal (DIP) joints (n=11). An important finding was an average diagnostic delay of 2.5 weeks, often following a misdiagnosis of soft tissue injury or infection. Patients were treated with colchicine, NSAIDS, oral steroids, intra articular cortisone injections. The majority of which had symptom resolution with either treatment, with 68% receiving a cortisone injection.
ConclusionsGout in the upper extremities is often misdiagnosed, leading to a delay in treatment by 2-4 weeks, resulting in morbidity due to the unchecked inflammation. A high index of suspicion for gout will help avoid delaying diagnosis and the associated patient morbidity. Corticosteroid injection is a highly effective first-line treatment, relieving pain and swelling. We hope this case series helps hand surgeons familiarize themselves with the demographics, clinical presentation, and treatments of gout and help them diagnose the disease earlier and treat the patients appropriately.
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