Your Gout Friend

Tophi vs Bone spur. Or is it gout?

Hello all,
My brother may be following in my gouty footsteps. I am attempting to help him diagnose his condition and chart a plan of action, using all the good information here. Yes, we are testing his UA.

He has a small lump on his foot that gets the flares. He claims to have had it x-rayed in the past, and diagnosed as a bone spur. I find this suspicious. Have any of you ever run into a misdiagnosis of tophi as a bone spur? Further, do you think it possible to mistake it even under an x-ray?

Thanks in advance for any thoughts.