A 55-year-old man with recurrent episodes of acute monoarthritis of the first metatarsophalangeal joint has hand and foot radiographs. These show eccentric, juxta-articular erosions with sclerotic margins and bony overhangs, with preservation of the joint space. Which arthritis does this pattern indicate?

• A Rheumatoid arthritis
• B Osteoarthritis
• C Psoriatic arthritis
• D Chronic tophaceous gout ✓

Explanation

Chronic gout produces eccentric, para-articular erosions with sclerotic borders and overhanging edges caused by tophaceous urate deposits eroding bone from outside the joint. Joint space is characteristically preserved until late disease. Rheumatoid arthritis produces marginal erosions at the bare area with uniform joint space narrowing and periarticular osteopenia. Psoriatic arthritis gives pencil-in-cup change and periostitis, while osteoarthritis shows cartilage space loss with osteophytes rather than punched-out erosions.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.