What will X-ray show in gout?

• A. Bite-like erosions
• B. Osteophytes
• C. Joint space widening
• D. Subchondral cysts

Answer: (A)

Gout on X-ray classically shows punched-out erosions at the margins of the joint, with sclerotic rims and overhanging edges created by tophaceous bone destruction. These bite-like (rat-bite) erosions are the hallmark radiographic feature because crystal-laden tophi erode bone in a distinctive way, often near the joint surface.

Osteophytes are more typical of osteoarthritis, reflecting bone spur formation rather than crystal-induced erosion. Joint space widening is not a characteristic early feature of gout and is more associated with other processes; gout can eventually cause reduced joint space as damage progresses, but widening isn’t typical. Subchondral cysts are commonly seen in osteoarthritis as well, and while bone changes can occur in gout, the most characteristic finding remains the bite-like erosions.