“ More common in men aged 30-60 years. Dysfunction in urate metabolism leads to an accumulation of urate in the tissues, where it crystalli...
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More common in men aged 30-60 years. Dysfunction in urate metabolism leads to an accumulation of urate in the tissues, where it crystallises. Monosodium urate crystals are negatively birefringent on polarised light microscopy. A total of 40% of patients with gout also have concomitant CPPD.
US
• Joint effusion with debris (crystals)—first metatarsophalangeal joint is classic (also ankle, knee, elbow and hands).
• ‘Double contour’ sign—hyperechoic line (crystal infiltration) lying on the hypoechoic cartilage.
• Synovitis.
• Bone erosions (often next to tophi) in chronic disease.
PLAIN FILM
- 45% have radiological features, not seen until 6-12 years after the initial attack.
- Look for soft tissue masses, preservation of joint space and bone density.
- Effusion is the earliest sign.
- Erosions are ‘punched out’, intra-articular/peri-articular, sclerotic and overhanging edges, often at the bases of the metacarpals.
MRI
• Tophi are low signal on T1 and heterogeneous signal on T2.
• Tophi may enhance.
• Bone oedema adjacent to erosions.
Gout. Foot x-ray demonstrating juxta-articular erosions affecting the first MTP joint with overhanging edges, preservation of bone density and marked surrounding soft tissue swelling and increased density/calcification in keeping with tophi.
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