Case contributed by Tim Wastney
Diagnosis almost certain


85-year-old male. Hand and foot pain.

Patient Data

Age: 85 years
Gender: Male

The DIP joint of the right index finger is affected by juxta articular erosion. The distal erosion has an overhanging margin. Some erosive change seen on the radial side of the IP joint of the right thumb. Also mild changes in the distal interphalangeal joints of the left index and middle fingers. Periarticular osteopenia is seen surrounding the MCP joints and IP joints of both hands.


Juxta-articular erosions with overhanging margins involving the metatarsophalangeal joint of both big toes, with associated soft tissue swelling and relative sparing of the joint space. Similar changes involving the distal interphalangeal joint of the left fourth toe. 

Case Discussion

Imaging appearances are fairly characteristic of gouty arthritis involving multiple joints in an asymmetric fashion. 

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