Ultrasound guided steroid injection for gout

What is Gout?

Gout is an inflammatory condition typically affecting the big toe joint, also termed the 1st metatarsophalangeal or 1st MTP joint, although it can affect any joint within the body. It results from increased blood uric acid levels, a condition known as Hyperuricemia. This usually results in the deposition of urate (uric acid) crystals within the joints and various soft tissues, causing pain, swelling and inflammation.

Gout affects over 1% of the population, and it is often observed in individuals with higher body mass index or reduced kidney function, like those with renal failure. Increased alcohol consumption and diets high in red meat are also risk factors for this condition. Gout is more prevalent in males, and its occurrence increases with age.

What are the causes of gout?

Gout is an inflammatory condition. It can result in acute joint pain and swelling triggered by increased uric acid levels, resulting in urate crystal deposition within a joint. Although its exact cause remains unknown, there are well-recognised risk factors for gout. These include:

Diets with high purine content, such as red meat, can cause increased uric acid levels and predispose to gout.
Alcohol. Increased consumption of beer and wine are reported risk factors.
Male gender. Gout is approx. 9 times more common in men.
Raised body mass index.
Reduced renal function/Kidney Failure
Certain medicines like Thiazide diuretics can precipitate a gout attack.
Gout can be caused by eating too many rich foods or drinking alcohol. A typical attack typically starts with severe joint pain affecting one joint in particular - most likely the big toe - before self-resolving within seven days and 90% likely returning within five years.

How to tell if I have Gout?

Gout attacks can happen quickly without any previous symptoms. Gout is typically a monoarticular disease, which tends to affect a single joint within the body. However, the involvement of a few joints or body parts is also common.

What are Gout symptoms?

The symptoms of Gout include:

Sudden intense joint pain, swelling and redness, particularly the big toe joint (also called the 1st metatarsophalangeal joint). The joint also typically gets hot and red and very tender to touch.
If there is any deposition of urate crystals within the soft tissues, this can lead to small nodules (called gout tophi).

What other conditions can mimic Gout?

Conditions that can be mistaken for Gout include:

Gout versus osteoarthritis of the big toe

Both gout and osteoarthritis can cause significant pain in the big toe. However, there are some differences between the two conditions. Heat and redness symptoms are more compatible with Gout. Osteoarthritis typically worsens over time, often starting as episodes that resolve on their own. It is more common in older adults (over 50) and can affect both men and women. Gout attacks, on the other hand, usually happen suddenly in younger people without prior toe discomfort. After each gout attack, the toe returns to its usual size and shape with a full range of movement. However, in osteoarthritis, patients may experience joint pain and stiffness. When this affects the big toe, it is termed hallux rigidus.

How to diagnose Gout?

The diagnosis starts with a clinical assessment performed by your doctor or a specialist. Blood tests may be ordered to measure your urate levels. Imaging plays a vital role in the diagnosis. X-rays are very useful. They can demonstrate small areas of bone loss (called erosions) characteristic of Gout. Also, Gout tophi tend to have a degree of mineralisation that can be picked up on X-rays. Diagnostic Musculoskeletal Ultrasound is also useful for assessment as it can show urate crystal deposition within the joints. It can also detect active inflammation of the joint lining, which is called synovitis. Synovitis is usually observed during the acute attack when the joint is inflamed and painful.

What is the treatment for Gout?

If Gout attacks are frequent, you should consult your doctor as you may need specific medicines like Allopurinol to reduce your blood uric acid level. During acute attacks, anti-inflammatory tablets like Naproxen are useful. Always consult your doctor before starting new medications.

Long-term Gout management requires different measures, including leading a healthier life with reduced alcohol intake, reducing red meat consumption and weight loss.

Ultrasound guided steroid injection for Gout.

Ultrasound-guided steroid injection can be very helpful to ease the pain and inflammation associated with an acute Gout attack by directly injecting corticosteroids into the joint. This would be suitable if you have one or a few joints affected. Cortisone is a powerful anti-inflammatory medication. Using ultrasound guidance ensures accuracy as the medicine will be delivered to the exact site of inflammation. Significant evidence shows that ultrasound guidance leads to better outcomes and fewer side effects than injections without guidance. To find out more, please see our FAQs.

How long will the effect of a cortisone injection last?

Current evidence suggests that cortisone can improve pain and function for up to 3 months, but in some cases, it can last longer.

How soon will a steroid injection start to work?

A steroid injection usually takes a few days before you notice the effect, although sometimes the pain relief can start on the same day. The injected area can feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection. To find out more, please see our FAQs.