1033 - Acute Management of Gout Flare with Intra-Articular Ketorolac Injection

81-year-old female with history of gout presented with acute right hallux gout flare during rehabilitation course in the hospital. On physical examination she had a right swollen great toe with 10/10 pain.  The patient did not want a corticosteroid injection due to the side effect profile but wanted immediate relief.   Ketorolac intra-articular injection option was discussed with the patient, and she agreed.   

30 mg of ketorolac and 2% lidocaine with a total volume of 1.5 milliliter were intra-articularly injected to the patient’s right first metatarsophalangeal joint under anatomic guidance. Within 24 hours the patient’s pain improved to a 1/10 pain on the visual analog scale. Patient was able to participate in daily therapy without pain and was discharge home.  The p</span>atient only received one dose of intra-articular ketorolac injection.  


Discussions: Acute gout flares are characterized by rapid onset of severe pain and common in the foot and knee. Common treatment of acute gout includes oral corticosteroids, nonsteroid anti-inflammatory drugs, and colchicine. Intra-articular injections with corticosteroids are also used for management of acute gout.  Unfortunately, these medications come with side effects and cautioned with patient with diabetes, kidney disease, and peptic ulcer. Intramuscular injections with ketorolac have been published with effectiveness, however, intra-articular injection administration of ketorolac has never been reported for the acute management of gout.  The use of intra-articular ketorolac injection in this case demonstrated to be as effective as intra-articular corticosteroid injection.   This administration into the joint also minimizes the systemic effect of ketorolac and provides an alternative to corticosteroids. 

Conclusions: This case report demonstrates the effectiveness and tolerance of intra-articular ketorolac for acute gout managemnt and should be consider for clinicians to use as an alternative or as a first line treatment.