The rationale for this study stems from the need to optimize pain management during IACI in Knee joint effusion in patients with Rheumatoid Arthritis. While IACI is a widely used and effective treatment for reducing joint inflammation and providing symptom relief in conditions such as rheumatoid arthritis and osteoarthritis, the procedure can cause significant pain, potentially limiting patient compliance and willingness to undergo repeated injections. Effective pain control is, therefore, essential for improving patient experience and ensuring the success of these therapeutic interventions. Both 10% xylocaine spray and EMLA cream are commonly used topical anaesthetics for a variety of procedures. However, there is limited data comparing their efficacy specifically in the context of IACI, especially in adult patients with inflammatory arthritis. This study aims to compare the anaesthetic effectiveness between these two widely used topical anaesthetic agents during IACI. The findings of this study will help clinicians select the most appropriate topical anaesthetic, thereby improving patient comfort, reducing procedural pain, and enhancing overall treatment adherence for patients with Rheumatoid arthritis undergoing IACI. By providing comparative data, this study will address the current gap in knowledge regarding optimal pain management strategies for IACI in this patient population.