A glucocorticoid and local anaesthetic injection (e.g. methylprednisolone + bupivacain) provides effective relief for acute gouty arthritis. The MTP joint space of the great toe is situated quite distally. Before the injection, locate the joint space by palpating the other toe, because the joint affected by acute gout is very painful and swollen. Use a thin needle and insert it in the direction of the joint space, deep enough but tangentially to the skin to ensure that the solution is injected into or close to the joint space and not under the skin.
Injection for acute attack of gout