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Key history Note the pattern of joint involvement (monoarticular or polyarticular), immediate and more recent history, family history and drug use.
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Enquire whether the joint pain is acute or insidious and confined to specific joints or fleeting as in rheumatic fever.
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Key examination A systematic examination of the affected joint or joints should look for signs of inflammation, deformity, swelling and limitation of movement.
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Searching for associated systemic disease such as connective tissue disorders and infection demands examination of the chest, heart and abdomen.
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FBE
ESR & CRP
Uric acid
Urine analysis
Joint X-rays
Synovial fluid analysis and culture
RA factor
Autoantibodies (ANA, dsDNA, ENA), anti-CCP antibody (for RA)
Other tests according to findings of tests for infection (e.g. specific serology, blood culture)
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Red flag pointers for polyarthritis
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Explanation: patient education and reassurance that arthritis is not the crippling disease perceived by most patients. Consider CBT.
Rest: during an active bout of inflammatory activity only.
Exercise: a graduated exercise program is essential to maintain joint function. Aim for a good balance of relative rest with sensible exercise.
Heat: recommended is heat packs, a hot-water bottle, warm bath or electric blanket to soothe pain and stiffness. Advise against getting too cold.
Diet: if overweight it is important to reduce weight to ideal level.
Physiotherapy: referral should be made for specific purposes such as exercises and supervision of a hydrotherapy program.
Occupational therapy: refer for advice on aids in the home.
Simple analgesics (regularly for pain): paracetamol is the basic analgesic (avoid opioids such as codeine or dextropropoxyphene preparations and aspirin if recent history of dyspepsia or peptic ulceration).
NSAIDs and aspirin: the first-line drugs for more persistent pain or where there is evidence of inflammation. The risk versus benefit equation always has to be weighed carefully. As a rule, NSAIDs (e.g. ibuprofen) should be used sparingly if possible. Aim for short courses of 14–20 d. The COX-2 specific inhibitors should be considered where there is an indication ...