Approach to patient With Rheumatic Pains

Good history and Physical Examination,

A good history and physical examination, coupled with knowledge of musculoskeletal anatomy, is most important when evaluating a patient with a rheumatic disorder.

this perhaps most important aspect of any patient evaluation. Not only it tells about the disease that a patient has but also about the problems that he is facing in day to day life. This information is very helpful in individualizing the treatment.

Investigations

Investigations should support your clinical examination and should be individualized on basis of patient profile.

Differentials

Patients with an acute inflammatory monoarticular arthritis need a joint aspiration to rule out septic arthritis and crystalline arthropathy. Most patients with a chronic inflammatory monoarticular arthritis of >8 weeks’ duration, whose evaluation has failed to define an etiology for the arthritis, need a synovial biopsy.

Gout usually does not occur in premenopausal women or affect joints close to the spine.

Most shoulder pain is periarticular (i.e., a bursitis or tendonitis), and most low-back pain is nonsurgical.

Patients with osteoarthritis affecting joints not normally affected by primary osteoarthritis (i.e., metacarpophalangeals, wrists, elbows, shoulder, ankles) need to be evaluated for secondary causes of osteoarthritis (i.e., metabolic disease, others).

Primary fibromyalgia does not occur for the first time in patients after the age of 55 years, nor is it likely to be the correct diagnosis in patients with musculoskeletal pain who also have abnormal laboratory values.

Rheumatoid Factor

All patients with a positive rheumatoid factor do not have rheumatoid arthritis.

Treatment

Treatment should be based on the disease and patient profile. The treatment should be individualized in each patient.