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Benefits of ultrasound guidance include: Higher accuracy the needle is visualised in real time, ensuring medication reaches the joint space Better suitability for small or deep joints gout frequently affects the first metatarsophalangeal joint (big toe), midfoot, and ankle, where blind injection is less reliable Reduced risk of complications fewer extra articular injections mean less chance of steroid depositing in surrounding soft tissues or blood vessels More consistent pain relief studies show more reliable short term improvements in pain and function It is worth noting that long term outcome differences between ultrasound guided and landmark guided injections are less well established, and the equipment and trained personnel required do increase cost