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 .
Ultrasound in gout: a useful tool for following urate-lowering therapy.
OBJECTIVE We aim ed to determine the ability of ultrasonography ( US ) to show decrease or disappearance of urate deposits in gouty patients requiring urate-lowering therapy ( ULT ) . METHODS To be included in this prospect i ve single-centre study , patients needed toexhibit ( 1 ) proven gout by monosodic urate ( MSU ) crystals in synovial fluid and ( 2 ) US- evidence d urate deposits ( double contour [ DC ] sign and /or tophi ) before starting ULT ( allopurinol [ n=4 ] , febuxostat [ n=12 ] ) . At baseline and after six months of ULT , one trained ultrasonographer assessed the knee and first metatarsophalangeal ( MTP1s ) joints . Serum uric-acid ( SUA ) level was assessed at baseline and at three and six months after ULT initiation . Correlation between US findings and achievement of SUA level objective ( < 360μmol/L ) was estimated by the kappa coefficient ( κ ) . RESULTS We studied 16 patients ( all males , mean age 61.0±18.3 years ) . The mean disease duration was 7.1±6.2 years . Tophi were found at clinical examination in 56 % of patients . Baseline SUA levels were 688±153μmol/L. At baseline , US revealed tophi or a DC sign among 62.5 to 75 % of patients in knees and 87.5 % in MTP1s . After six months of ULT , none of the four patients , not achieving the SUA level objective , had disappearance of US features . Among the remaining 12 patients , US features ( tophi or DC sign ) disappeared or decreased in all but one with a stable DC sign in one MTP1 . The correlation between the whole US examination and SUA level was excellent ( κ=0.875 ) . CONCLUSIONS US could show disappearance of urate deposits after ULT and appears to be well correlated with efficacy of ULT
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 .