In some parts of the United States, players add a wild variation to Setback (also known as Pitch, Cinch, or Smear) by placing a joker in the deck, which introduces a fifth point into the game. Typically the joker counts as the lowest trump card, ranking below the 2, though some people treat it as ranking between the jack and ten. (Some versions of the game treat the joker as the highest trump card, which can be a problem because it can lead to a normal bid getting beaten by the presence of an unpredictable factor.) The joker point goes to whoever wins the trick with the joker in it.

Another variation, perhaps derived from Euchre, is to add the jack of the same color as an extra trump between the jack and the ten (called the jick) and to treat the joker as the lowest trump, with a point to whoever wins the trick with either of them in.

The existence of the joker doesn't affect the status of the point for the low trump card, which still goes to the lowest trump in play other than the joker. However, playing with the joker provides an argument for saying that the low point goes to whoever is dealt the low trump card rather than whoever wins the trick with the low trump card in it. Otherwise, the point for the joker and the point for the low trump card are awarded in identical fashion.

If the pitcher leads the joker at the first trick, he can name whatever trump suit he wants. However, leading the joker isn't normally a sound tactic because you want to save the joker to win a trick with it.