The following left hand x-ray is from a 70 year old woman experiencing pain and swelling in the left index finger. What can be seen?

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The x-ray shows abnormality around the distal IP joint of the index finger and there are well-defined punched out, periarticular erosions with overhanging margins. There is a surrounding soft tissue swelling which is compatible with a tophus. These findings are consistent with a tophaceous gout.

Causes of distal IP joint arthritis are:

• Osteoarthritis
• Gout
• Psoriatic arthritis

In contrast, rheumatoid arthritis involves the PIP joint.

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