Medically Fit For Exams
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Joint pain history taking

 

Differential diagnoses

Osteoarthritis

Rheumatoid Arthritis

Psoriatic arthritis

Lupus

Tendonitis

Bursitis

Polymyalgia rheumatica

Gout

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Ask if it’s okay to talk to the patient before they see the doctor

 

History of presenting complaint

  • ‘What has brought you in today?’
  • ‘Can you tell me more about the pain?’

 

Site

Onset

Character

Radiation

Associated symptoms

Time-course

Exacerbating/relieving factors

Severity

  • Use the SOCRATES mnemonic
    • Polyarticular (multiple joints)
    • Oligoarticular (2 to 4 joints)
    • Monoarticular (1 joint)
    • Symmetrical?
  • Morning stiffness >30 mins (RA) or <30 mins (OA)
  • Relieved (OA) or exacerbated (RA) by exercise
  • Pain on specific movements?
  • Pain on palpation? (Eg trochanteric bursitis on pressing GT)
  • Numbness/tingling/shooting (neurological)
  • Site
    • Shoulder and pelvis (PMR)
    • Small/distal joints (RA)
    • Large joints (OA)
  • Associated symptoms
    • Systemic inflammation (RA)
      • Weight loss
      • Fever
      • Malaise
      • Fatigue
      • Night sweats
    • Psoriasis (PA)
  • Ask about the impact that the pain has had on the patient and their daily living
  • Summarise and check what the patient has told you

 

Past medical history

  • Ask if the patient has had any other health problems in the past
  • Ask especially about inflammatory conditions
  • Autoimmune conditions

 

Family history

  • Ask if anyone in the family has had joint problems
  • Ask if anyone in the close family has had any serious health conditions

 

Drug history

  • Are they taking any regular medication?
  • Do they take any over the counter medication?
  • Do they take any supplements?

 

Allergies

  • Do they have any allergies?
    • If yes, to what? What happens?

 

Social history

  • Smoker?
  • Alcohol?
  • Occupation?
  • With whom/where they live (especially for older patients)
  • Assess risk of STIs (gonococcal arthritis)
    • Is there any chance you could have picked up a sexually transmitted infection in the last year?

 

Summary

  • Ask if the patient has any questions or anything they’re concerned about
  • Ask if there’s anything else that you haven’t asked
  • Summarise again if necessary
  • Thank the patient for talking to you

 

 

Joint pain history taking.docx
Microsoft Word document [16.0 KB]

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