Gouty erosions

A collage of gout… all from the same 80 year old male patient. The radiographic features that help distinguish gout from other forms of erosive arthritis include the presence of sclerotic (dense) margins, overhanging edges (spicules of residual bone at the margins of erosions), erosions that are relatively remote from the joint (and therefore not due to synovitis), lack of symmetry, dense soft tissue nodules and, of course, a predilection for the big toes of old men. In this example, showing the fifth finger, distal ulna and big toe, many of these characteristics are evident. The orange arrows indicate erosions with sclerotic margins. The white arrow is pointing to an overhanging edge. The blue arrows point to an erosion that is fairly remote from the joint line. The yellow arrows indicate some soft tissue nodules (tophi) that are subtle but definitely denser than the surrounding soft tissues.