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