A 35-year-old man presents with intermittent painful inflamed, swollen joints, that worsen during sleep. What does the hand X-ray show?

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 Multiple well defined punched out erosive lesions with sclerotic changes in a juxta-articular pattern are visualized via X-ray. Over-hanging edges, sometimes known as rate-bite erosions, are seen at these locations. 

Surrounding soft tissues may demonstrate pathogomonic tophi which appear as opacities adjacent to the joint spaces on radiograph. Joint effusions can be seen. The joint space is intact in earlier stages of disease, but, in late-stage disease, there is joint space narrowing.

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What is your diagnosis from this hand X-ray?

Image IQ Quiz: Patient Presents with Swollen Joints