Gouty arthropathy affecting the first metatarsophalangeal joint causes characteristic X-ray changes. The EARLIEST radiographic finding in tophaceous gout is:

• A Juxta-articular osteoporosis
• B Joint space narrowing
• C Punched-out erosions with overhanging edges ('rat-bite' lesions) away from joint margin
• D Soft tissue swelling only ✓

Explanation

The radiographic sequence in gout: early attacks show only soft tissue swelling; later, tophi deposits cause characteristic 'punched-out' erosions with sclerotic margins and overhanging edges ('rat-bite'), typically in the periarticular bone but away from the joint margin — unlike RA, which shows juxta-articular osteoporosis early. Joint space narrowing is a late finding in gout (cartilage preserved until late) whereas RA shows early joint space narrowing. The absence of periarticular osteoporosis and the overhanging edge help distinguish gout from RA radiographically.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.