This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Joint disorders, Subject name: Orthopaedics
42 yrs male with frequent attacks of joint pain, underwent an X-ray showing soft tissue swelling. The likely diagnosis is: 
Select and explain. 
A. Gout, B. Parathyroid adenoma, C. Psoriasis, D. RA
A: Gout
Answer: A: Gout 
Explanation: Tophi appear as characteristic punched out cysts or deep erosions with over hanging bony edges -Mael's or G' sign. GOUT:- Sometimes only feature is acute pain and tenderness. hyperuricemia is not diagnostic and is often seen in normal middle aged men. During acute attack X-rays show only soft tissue swelling. Chronic gout may result in joint space narrowing and secondary OA.