Acute gout most frequently involves the first
metatarsophalangeal (MTP) joint at first presentation. However, it has
non-specific radiographic features. Chronic gout has a characteristic radiographic appearance with tophus considered
to be a hallmark feature.
Tophi are seen as focal eccentric soft tissue
swelling of the affected joints or soft tissues resulting in a "lumpy
bumpy appearance" and cause well-defined punched out juxta-articular
erosions with sclerotic rims and overhanging edges due to pressure on the
adjoining bone. Normal bone mineralisation and joint spaces are preserved till
late in the disease.
It occurs in asymmetrical polyarticular
distribution with involvement of the feet, ankles, knees, hands, and elbows, in
decreasing order of frequency
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