For common presentations, junior doctors should be aware of the following:

• Acute Arthritis:
  • Timing of onset
  • Number of joints involved (e.g. monoarticular, oligoarticular, polyarticular)
  • Nature of symptoms/signs (e.g. swelling, erythema, restricted range of motion)
  • Risk factors for septic arthritis (e.g. current bacteraemia)
  • Concurrent infection
  • History of recent travel
  • History of sexual exposures
  • Whether patient has a pre-existing rheumatological condition (e.g. rheumatoid arthritis) and if so, what their pre-existing medication regime is (e.g. immunosuppression)
  • Results of urate level, inflammatory markers and autoimmune screen
  • Whether joint aspiration has been undertaken and if so, what the results are
  • Whether treatment has been initiated and if so, with what
• Suspected Giant Cell Arteritis (GCA):
  • Age of patient
  • Timing of onset
  • Headache / scalp tenderness
  • Jaw claudication
  • Visual disturbance
  • Symptoms of polymyalgia rheumatica (PMR)
  • Whether temporal arteries are prominent / pulsatile / tender
  • Results of inflammatory markers
  • Whether Ophthalmologists have been notified
• Management of Gout or Pseudogout
  • Timing of onset
  • Number of joints involved
  • Precipitating factors (e.g. acute illness, renal failure)
  • Comorbidities (e.g. ischaemic heart disease, diabetes)
  • Concurrent infection
  • Whether diagnosis confirmed (e.g. joint aspiration)
  • If previously confirmed gout, usual approach to management of flares
  • Whether patient on urate-lowering therapy and if so, whether compliant
  • Results of urate level, renal function and inflammatory markers
  • Whether treatment has been initiated and if so, with what
• Management of Mechanical Joint Pain
  • Age of patient
  • Comorbidities and functional status
  • Timing of onset
  • Precipitating factors (e.g. trauma, fall)
  • Contraindications to intra-articular steroid injections
  • Results of investigations thus far (e.g. blood tests, imaging)
  • Whether treatment has been initiated and if so, with what
• Management of Back Pain
  • Age of patient
  • Nature of back pain (e.g. mechanical vs inflammatory features)
  • Whether associated radiculopathy (e.g. weakness, which should prompt neurosurgical review)
  • Timing of onset
  • Precipitating factors
  • Findings on lower limb neurological examination and straight-leg raise
  • Results of investigations thus far (e.g. blood tests, imaging)
  • Whether treatment has been initiated and if so, with what
    • If previous spinal injections or surgery, details around timing and outcomes
  • Impact on mobility

• Examination:
  • Joint Problems: site, swelling, erythema, warmth, range of motion (active and passive)
  • Suspected GCA: temporal artery prominence, temporal artery pulsatility, temporal artery tenderness, visual acuity
  • Back Pain: spinal and paraspinal tenderness, spinal movements, sacroiliac joint tenderness, lower limb neurological examination, straight-leg raise
• Investigations:
  • Basic blood tests
  • Urate level
  • Inflammatory markers
  • Autoimmune screen, depending on problem
  • If inflammatory markers high, ensure other sources looked into (e.g. urine culture, blood cultures)
  • Plain X-rays +/- more advanced imaging, depending on problem
  • Joint aspiration (but avoid if underlying joint replacement)

• If confirmed rheumatological condition, history of medication regime
• If monoarthritis in context of confirmed rheumatological condition (e.g. rheumatoid arthritis), to consider possibility of septic arthritis instead of assuming secondary to underlying condition
• If suspected GCA, whether symptoms of PMR
• If presumed gout or pseudogout, whether diagnosis confirmed on joint aspiration previously
• If relevant imaging or interventions done previously, to give details (e.g. results of advanced imaging, timing of previous intra-articular steroid injections)

• Not ordering useful tests (e.g. urate level, inflammatory markers, plain X-rays)
• Not checking whether joint aspiration has occurred previously and its results
• Not mentioning comorbidities (e.g. ischaemic heart disease, diabetes), which are of particular importance when prescribing NSAIDs and steroids