Recurrent acute gout attacks may lead to changes in joint structure visible on plain radiographs. In the x-ray film of the foot below, note the large radiopaque tophus over the second metatarsophalangeal joint and the periarticular punched-out erosions along the long axis of the bone, with overhanging edges and sclerotic rims. Joint space is generally very well preserved until late in the course of disease.
