Radiographs were available for study for 466 of 2,000 patients with primary gout who were followed clinically for as long as 30 years. The radiographic manifestations at various stages of the disease and the effect of therapy were studied in 80 patients. New radiographic signs, such as lace pattern, intracortical lesions, and subchondral compressions, are emphasized as well as the frequency of tophaceous lesions affecting the dorsum of the feet.