Yes. Create a primary key on both itemId and userId.
To do this in T-SQL (SQL Server) you would use something like:
CREATE TABLE rating (
itemId int NOT NULL
CONSTRAINT fk_rating_item FOREIGN KEY REFERENCES item ( itemId ),
userId int NOT NULL
CONSTRAINT fk_rating_user FOREIGN KEY REFERENCES [user] ( userId ),
thumbsUp int,
thumbsDown int,
CONSTRAINT pk_rating PRIMARY KEY ( itemId, userId )
)
(This assumes your items table is 'item' and your users table is 'user'.)
I'm not sure why you have a value for both thumbs up and thumbs down? If this is a boolean value, you might only need one: if thumbs up is 0, then that's effectively thumbs down anyway.
Edit: Definition of composite keys
When you create a primary key on two columns in one table, that means it is only required to be unique for both values, i.e. it will allow for any number of rows with the same itemId as long as each userId is different, and vice-versa.
It's the combination of the two that must be unique, not each part of the key individually.