This elderly male came with a history of recurrent attacks of pain and swelling in the great toe in the past. This is the present x-ray of the hands. The diagnosis can be confirmed by
Radiological features in GoutSoft tissue findingsCalcific deposits in gouty tophi in 50% (only calcium urate crystals are opaque)Eccentric juxta-aicular lobulated soft-tissue masses (hand, foot, ankle, elbow, knee)Bilateral olecranon bursitisAural calcificationJoint findingsPreservation of joint space initiallyAbsence of periaicular demineralizationErosion of joint margins with sclerosisCailage destruction late in course of diseasePeriaicular swelling (in acute monaicular gout)Chondrocalcinosis (menisci, aicular cailage of knee) resulting in secondary osteoahritisBone findings"Punched-out" lytic bone lesion +- sclerosis of margin"Mouse / rat bite" from erosion of long-standing soft-tissue tophus"Overhanging margin" (40%)Ischemic necrosis of femoral/humeral headsBone infarctionDiagnosis of gout relies on the identification of MSU crystals under a compensated polarized light microscope (CPLM) in synol fluid aspirated from the patient's joint.
Anti CCP antibodies
Polarised microscopy of tissue fluid aspirate
Xray of lumbosacral spine
HLA B27
All India exam