31st January 2024

Imaging

• X-rays in gout: asymmetrical punched-out erosions, tophi in chronic gout (occurs years after the initial attack). Preservation of joint space. Punched-out lytic lesions are also seen which can be large. During an acute flare, inflammatory changes can also be seen on radiographs but are non-specific.

Image Source: Wikimedia Commons (2013). Gicht-Roe-multiple Arrosionen Destruktionen, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Gicht_-_Roe_-_multiple_Arrosionen_Destruktionen.png (Accessed: 30 April  2022).

• X-rays in pseudogout: chondrocalcinosis. Chondrocalcinosis is not specific to pseudogout and is often present asymptomatically.

Image Source: Wikimedia Commons (2016). Chondrocalcinosis-annotated, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Chondrocalcinosis_-_annotated.jpg (Accessed: 30 April  2022).

• NICE do not recommend further imaging if gout or pseudogout is suspected, as it is often a clinical diagnosis. However, if there is doubt and further imaging is recommended, then modalities such as ultrasound, MRI and CT scan can be considered.