Background: Gout is a common presenting complaint in the emergency department. Ultrasound-guided intra-articular corticosteroid injections have been previously described in rheumatology literature for the treatment of acute gout. Emergency medicine providers commonly encounter gout and possess the necessary skill set to treat patients with intra-articular injections. This can be a safe, low-risk, and effective treatment, particularly in patients with contraindications to standard therapy, such as those with renal impairment and other comorbidities.

Case Report: Four patients underwent ultrasound-guided intra-articular steroid injections in the emergency department for the treatment of gout and pseudogout in three metatarsophalangeal joints and one radiocarpal joint. These patients were given injections based on risk factors precluding them from receiving standard oral therapy, their ability to receive oral and injection therapy, or personal preference.