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