Colchicine effects on septic joint

[Creflo]

If you aren't sure if apparent gout in lesser toe is septic joint, what is your initial treatment protocol? How do you feel about giving colchicine in this situation? Would using colchicine decrease the body's immune response if the joint is septic?

I know it is best to aspirate the fluid, but I've tried this in a lesser toe and wasn't able to obtain a useful amount of fluid.

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[AttackNME]

If the pt isn't septic and after a failed attempted joint aspiration, I'd feel comfortable giving colchicine, I would just do a ton of counseling so that they know I'm hedging my bets (i.e. I would say "Sir, I'm 90% sure it's gout, but there is a small chance I'm wrong. Just keep an eye on it, if its getting worse and if you start to feel sick, go back to the ER and call me asap!")

If they ask why not just also give me antibiotics to cover both, then I'd explain briefly we don't want them to develop resistance and run into problems in the future, it's not without side effects, this is also treatment/diagnostic meaning we're not completely sure its gout but if you get better taking this medicine, then its therapeutic and pretty diagnostic of gout so you know in the future if this happens again you know what it feels like.

 

[sinustarsi]

I think documenting that you aspirated is key here. I use mini-arm and give copy to the pt also. sometimes adding little fluid in the joint and re-aspirating can be helpful. You can send that to the lab. We used to take aspirates to the lab ourselves and look at crystals as residents. Very valuable experience. I also use Kocher's criteria in a child. I always get labs/vitals as baseline and add even consider uric acid level. I don't know the role of uric acid level since that can be normal. I never give abx unless I know I am treating infection. I am always upset when the ED start them on IV abx before they consult us.