Station 2: Joint pain

Presenting complaint:

- joint pain

HOPC:

- which joint? symmetrical versus assymetrical? small joint versus large joint (ie: spine)

- duration acute versus chronic, if acute try to establish timeline (how often is the joint flare), duration of each attack

- aggravating or relieving factors ? is it worse with activity or rest

- morning stiffness if presence, duration of EMS

- associated features including swelling, redness, restriction in range of movement, change in sensation, change in color of the joint

- systemic features: fever, loss of appetite, loss of weight, lethargy

- other features suggestive of diagnosis:

• RA: EMS, deformity, presence of nodule at the elbow, any SOB or cough (? ILD), red painful eye (uveitis)
• systemic sclerosis: skin itch and tightening, ulcer at the digits, change in color (? Raynaud's   phenomenon), difficulty swallowing, reflux, change in bowel habit
•  sjogren: sicca symptoms
• SLE: any photosensitivity rashes, hair loss, chest pain (pericarditis), SOB (pleuritis)
• gout: sudden onset, precipitating factors (high purine foods)
• psoriasis: skin rashes (silvery plaques with scaling), family history of psoriasis
• reactive arthritis (Reiter's syndrome): rashes on the feet and sole (keratoderma blenorrhagica), penile discharge, urinary symptoms (uretritis), conjunctivitis, if present need to take further     sexual history
• enteropathic (IBD-related arthropathy): change in bowel habit, mouth ulcer
• anykylosing spondylitis: spine involvement, SI joint pain with EMS, better with activity

- recent trauma or injury

Past medical history:

- of gout, autoimmune illness
- malignancy

Medications, drug allergies:

- use of analgesia ie: NSAIDS
- active medications (ie: HCTZ than can precipitate gout, procainamide or hydralazine can cause drug-induced lupus)

Family history:

- of autoimmune illness- RA, ankylosing spondylitis
- of psoriasis

Social history:

-  occupation -> repetitive strain injury or trauma
- smoking and alcohol history
- how is patient coping at home and work? Any social support
- assess daily ADL and functional status

ICE:

- check patient's ideation, concern and expectation and how the pain impact on their life


The end