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 .
Development of a computed tomography method of scoring bone erosion in patients with gout: validation and clinical implications.
OBJECTIVES To develop a method of scoring bone erosion in the feet of patients with gout using CT as an outcome measure for chronic gout studies , consistent with the components of the OMERACT filter . METHODS Clinical assessment , plain radiographs and CT scans of both feet were obtained from 25 patients with chronic gout .  CT scans were scored for bone erosion using a semi-quantitative method based on the Rheumatoid Arthritis MRI Scoring System ( RAMRIS ) .  CT bone erosion was assessed at 22 bones in each foot ( total 1100 bones ) by two independent radiologists . A number of different models were assessed to determine the optimal CT scoring system for bone erosion , incorporating the frequency of involvement and inter-reader reliability for individual bones . RESULTS An optimal model was identified with low number of bones required for scoring ( seven bones/foot ) , inclusion of bones over the entire foot , high reliability and ability to capture a high proportion of disease . This model included the following bones in each foot : first metatarsal ( MT ) head , second to fourth MT base , cuboid , middle cuneiform and distal tibia ( range 0 - 140 ) . Scores from this model correlated with plain radiographic damage scores ( r = 0.86 , P < 0.0001 ) and disease duration ( r = 0.42 , P < 0.05 ) . Scores were higher in those with clinical ly apparent tophaceous disease than in those without tophi ( P < 0.0001 ) . CONCLUSIONS We have developed a preliminary method of assessing bone erosion in gout using conventional CT . Further testing of this method is now required , ideally in prospect i ve studies to allow analysis of the sensitivity to change of the measure
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 .