A 55-year-old man with recurrent attacks of acute monoarthritis has a foot radiograph showing eccentric juxta-articular erosions with sclerotic margins and overhanging bony edges at the first metatarsophalangeal joint, with relative preservation of the joint space. The most likely diagnosis is:
- A Rheumatoid arthritis
- B Chronic tophaceous gout ✓
- C Osteoarthritis
- D Psoriatic arthritis
Correct answer: B. Chronic tophaceous gout
Explanation
Punched-out juxta-articular erosions with sclerotic borders and overhanging edges (Martel sign), eccentric soft tissue tophi, and preservation of joint space until late disease are classic for chronic tophaceous gout. Rheumatoid arthritis produces marginal erosions at the bare area with periarticular osteopenia and uniform joint space narrowing, features absent here. Psoriatic arthritis gives pencil-in-cup change and periostitis rather than overhanging edges.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.