Presentation: 35 year old man presents with intermittent painful inflamed, swollen joints especially worst during sleep.
Diagnosis: Chronic tophaceous gouty arthritis.
Findings on Imaging:
- Imaging studies such as x-ray may show evidence of gout in the hand.
- On x-ray, gout can present as periarticular erosions with overhanging edges, and in advanced cases, there may be tophaceous deposits.
- Multiple well defined punched out erosive lesions with sclerotic changes in a juxta-articular pattern can be seen
- Over-hanging edges sometimes known as rate-bite erosions are seen at these locations. Surrounding soft tissues may demonstrate pathogomonic tophi which appear as opacities adjacent to the joint spaces on radiograph.
- Joint effusions can also be seen.
- In this case, the joint space is intact in earlier stages of disease but there is in late stage disease joint space narrowing.
Next Steps in Management:
- Management of gout in the hand typically involves a combination of medication and lifestyle changes.
- Medications may include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids.
- Lifestyle changes such as weight loss, exercise, and dietary modifications may also be recommended.
- Regular monitoring and follow-up imaging may be necessary to assess the progression of the disease and the effectiveness of treatment.
Key Take Away Points:
- Gout is a form of arthritis caused by the deposition of uric acid crystals in joints and tissues.
- Imaging studies such as x-ray or ultrasound can help diagnose gout in the hand by showing evidence of periarticular erosions, tophaceous deposits, or hyperechoic nodules.
- Treatment of gout in the hand may include medication and lifestyle changes, and regular monitoring and follow-up imaging may be necessary.
Credit: Case submitted by Dr. Mohammed MD to radRounds Radiology Network
