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-rayof the hands. The diagnosis can be confirmed by

Gout The metabolic disease that affects middle-aged to elderly men and postmenopausal women. It results from an increased body pool of urate with hyperuricemia. Characterized by episodic acute and chronic ahritis caused by deposition of MSU crystals in joints and connective tissue tophi and the risk for deposition in kidney interstitium or uric acid nephrolithiasis. Usually, only one joint is affected initially and the metatarsophalangeal joint of the first toe is the most commonly involved joint. Radiological features - Cystic changes, well-defined erosions with sclerotic margins (often with overhanging bony edges), and soft tissue masses are characteristic Diagnostic modalities - Ultrasound, CT, and MRI are being studied and are likely to become more sensitive for early changes Ref: Maheshwari 6e pg 293.