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Rationale:
- Although highly suggestive, radiographic abnormalities may not be diagnostic for gout.
- Any inflammatory arthritis may lead to diffuse joint-space narrowing, indicating cartilage loss; this tends to be a relatively
late finding in gout.
- Tophi may appear as soft-tissue masses or bony erosions that are intraarticular, periarticular, or at a distance from the
joint.
- Erosions from tophi may involve both opposing articular surfaces and be associated with new bone formation with an overhanging
osteophyte, making it appear as if the tophus is migrating into the bone or joint. This appearance of erosion differs distinctly
from that seen in rheumatoid arthritis.
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Evidence:
- Radiologic changes are described in a clinical and radiographic assessment of tophaceous gout (31).
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Comments:
- Magnetic resonance imaging may show cystic changes in bone, bone “edema,” soft-tissue pannus, and swelling. Tophi often contain
calcium, making their appearance differ from that of synovitis in rheumatoid arthritis (32).
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Grace P. Teal, MD (deceased) has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Howard A. Fuchs, MD, is a consultant for TAP Pharmaceuticals.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Gout
> Diagnosis
