Recently gout has been recognized as a cause of inflammation in patients with nodal osteoarthritis. We reviewed the clinical data and radiographs of four patients with known osteoarthritis of the interphalangeal joints of the hands who developed gout. Radiographic changes of osteoarthritis in the affected interphalangeal joint were present in all four patients. In our cases, radiographic findings were typical of gout in one patient, including the presence of large eccentric soft tissue masses and periarticular erosions. In three patients, radiographic findings were non-specific, including only a small eccentric nodule in one patient, diffuse soft tissue swelling in a second, and a large calcified soft tissue mass with bony erosions in a third. Whenever a patient with inter-phalangeal joint osteoarthritis presents with an acute episode of inflammation the possibility of gout should be considered. Recognition of gout will allow the timely initiation of appropriate therapy.