A 45-year-old man has recurrent acute arthritis of the first metatarsophalangeal joint. Radiograph of the foot shows eccentric juxta-articular erosions with sclerotic margins and overhanging edges, with preservation of the joint space and no periarticular osteopenia. The most likely diagnosis is:
- A Rheumatoid arthritis
- B Psoriatic arthritis
- C Osteoarthritis
- D Gouty arthritis ✓
Explanation
Punched-out juxta-articular erosions with overhanging margins (Martel sign), sclerotic borders, eccentric soft tissue tophi, and a preserved joint space with absent periarticular osteopenia are classic radiographic features of chronic tophaceous gout. Rheumatoid arthritis produces marginal erosions at the bare areas with uniform joint space narrowing and periarticular osteopenia, which distinguishes it from gout. Psoriatic arthritis shows pencil-in-cup deformity and periostitis, while osteoarthritis shows osteophytes and asymmetric cartilage loss without overhanging erosive margins.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.