A 51-year-old woman with seronegative rheumatoid arthritis had pain in the base of the right big toe during walking. Restriction of plantar flexion is observed, and flexing the joint causes slight pain. A mixture of methylprednisolone and bupivacain (total volume 0.8 ml) is injected into the joint. The joint space which is situated distal to the thickest part of the joint is located by palpating. The healthy side is palpated first because the joint space is easier to feel in an unaffected joint. A thin needle is inserted tangentially in the direction of the joint space. The needle need not be inserted deeper into joint. The drug is injected slowly, and a pinch grip after the injection prevents the fluid from leaking out.
Glucocorticoid injection into MTP joint of the big toe in a patient with rheumatoid arthritis