1st MTP pain was a prominent feature in people with gout .
Imaging features were common at the 1st MTP including the double contour sign , tophi and erosions .
Conclusions 1st MTP acute arthritis is highly prevalent in people with gout and has a substantial impact on patient-reported pain and disability .
Gout affects the structure and function of the 1st MTP .
Microscopic and imaging studies have demonstrated crystal deposition and joint damage at the 1st MTP in people with gout
Background The aim of this review was to qualitatively synthesis e studies that have investigated characteristics of the  first metatarsophalangeal joint ( 1st MTP )  in gout and to undertake a meta- analysis to estimate the average prevalence of acute 1st MTP arthritis across studies in people with gout .
Relationship between structural joint damage and urate deposition in gout: a plain radiography and dual-energy CT study
Objectives The aim of this work was to examine the relationship between joint damage and monosodium urate ( MSU ) crystal deposition in gout . Methods Plain radiographs and dual-energy CT ( DECT ) scans of the feet were prospect ively obtained from 92 people with tophaceous gout . Subcutaneous tophus count was recorded . The ten metatarsophalangeal joints were scored on plain radiography for Sharp – van der Heijde erosion and joint space narrowing ( JSN ) scores , and presence of spur , osteophyte , periosteal new bone and sclerosis ( 920 total joints ) . DECT scans were analysed for the presence of MSU crystal deposition at the same joints . Results  DECT MSU crystal deposition was more frequently observed in joints with erosion ( OR ( 95 % CI ) 8.5 ( 5.5 to 13.1 ) ) , JSN ( 4.2 ( 2.7 to 6.7 % ) ) , spur ( 7.9 ( 4.9 to 12.8 ) ) , osteophyte ( 3.9 ( 2.5 to 6.0 ) ) , periosteal new bone ( 7.0 ( 4.0 to 12.2 ) ) and sclerosis ( 6.9 ( 4.6 to 10.2 ) ) , p<0.0001 for all . A strong linear relationship was observed in the frequency of joints affected by MSU crystals with radiographic erosion score ( p<0.0001 ) . The number of joints at each site with MSU crystal deposition correlated with all features of radiographic joint damage ( r>0.88 , p<0.05 for all ) . In linear regression models , the relationship between MSU crystal deposition and all radiographic changes except JSN and osteophytes persisted after adjusting for subcutaneous tophus count , serum urate concentration and disease duration . Conclusions MSU crystals are frequently present in joints affected by radiographic damage in gout . These findings support the concept that MSU crystals interact with articular tissues to influence the development of structural joint damage in this disease
1st MTP pain was a prominent feature in people with gout .
Imaging features were common at the 1st MTP including the double contour sign , tophi and erosions .
Conclusions 1st MTP acute arthritis is highly prevalent in people with gout and has a substantial impact on patient-reported pain and disability .
Gout affects the structure and function of the 1st MTP .
Microscopic and imaging studies have demonstrated crystal deposition and joint damage at the 1st MTP in people with gout
Background The aim of this review was to qualitatively synthesis e studies that have investigated characteristics of the  first metatarsophalangeal joint ( 1st MTP )  in gout and to undertake a meta- analysis to estimate the average prevalence of acute 1st MTP arthritis across studies in people with gout .