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First metatarsophalangeal joint aspiration using a 29-Gauge needle
  1. Francisca Sivera (sivera_fra{at}
  1. Hospital General Universitario de Alicante, Spain
    1. Raul Aragón (raul_antonioa{at}
    1. Hospital General Universitario de Alicante, Spain
      1. Eliseo Pascual (pascual_eli{at}
      1. Hospital General Universitario de Alicante, Spain


        Objectives: To assess the clinical feasibility of aspirating symptomatic and asymptomatic first metatarsophalangeal (MTP) joints with a 29-gauge needle in order to obtain a synovial fluid (SF) sample.

        Methods: All consecutive aspirations of first MTP joints performed at our department were prospectively recorded. The procedure was considered successful if the SF sample volume was enough to perform a crystal search. Crystals were identified using a polarized light microscope (magnification 400x) with a first order red compensator. Pain was recorded in a 10-cm visual analogue scale (VAS).

        Results: Aspirations were attempted in 33 first MTP joints in 31 patients. SF was drawn from 30 of the joints (91%), with little difference between asymptomatic (89%) and inflamed joints (93%). The technique was well tolerated (mean VAS 1.74). Urate monosodium crystals were identified in 22 samples (73%) and another sample contained calcium pyrophosphate dihydrate crystals.

        Conclusions: 29-gauge needles allow easy aspiration of the 1st MTP joint with only modest discomfort for the patients and generally yield a SF sample of sufficient volume for crystal detection and identification.

        • GOUT
        • PODAGRA

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