1. Presenting complaint
2. Pain: jointslimbselsewhere
3. Stiffnessswelling
4. DeformityRaynaud's
5. Eyesmouth
6. Systemic
7. Past medicalsurgical history
8. Familysocialdisabilitydrug history

Presenting complaint

• What is the problem lately.

Pain: joints

• See SOCRATES.
• Site: number of jointssymmetrical/ asymmetricallarge/ small jointssequence affected.
• Timing: acute/ chronic.
• Exacerbating factors: restexercise.

Pain: limbs

• See SOCRATES.
• Bone pain.
• Severe pain of sudden onset (vascular dz).
• Nerve entrapment.
• In amputated limb (phantom pain).

Pain: elsewhere

• See SOCRATES.
• Back is common.
• Spinal cord: localize to dermatome.

Stiffness

• Generalized or specific to certain joints.
• Number of jointssymmetrical/ asymmetricallarge/ small jointssequenceaffected.
• Worse in morning (RAother inflammatory).
• Duration before wears off (severity).

Swelling

• Number of jointssymmetrical/ asymmetricallarge/ small jointssequenceaffected.
• When first noticed.
• Getting larger or smaller.

Deformity

• Misshapen joints.
• Time course of the deformity.

Raynaud's

• Assess Raynaud's phenomenon (scleroderma).

Eyesmouth

• Dry eyesmouth (Sjogren's).
• Red eyes  painful eyes (seronegatives).
• Unilateral loss of visual acuity (seronegatives).

Systemic

• Rash (SLE).
• Fatiguebreathlessness.
• Fever (connective tissue dz).
• Weight loss (dyspagia or malabsoption 2° to scleroderma).
• Abdominal painGI bleeding (NSAID s/e).

Past medicalsurgical history

• Time of menopause [if applicable].
• Current problem in past.
• Trauma in past.
• Fracturessprains.
• Infections:
  • Gonorrhea [esp. if monoarticularyoung].
  • Staphylococcus
  • Streptococcus
  • Hepatitis
  • TB
  • Dysentery
• Gout (gouty arthritis).
• IBD (IBD-associated arthritis).
• Psoriasis (psoriatic arthritis).
• Thyroid problems (osteoporosis).
• Tick bites (Lyme dz) [usu. USA only].
• Arthritis as a child.
• Depression [common in chronic disability].
• Seen a rheumatologist before?.
• Physiotherapyoccupational therapy.
• Joint surgerybone surgery.

Family history

• The current complaint in parents/ siblings/ children: healthcause of deathage ofonsetage of death.
• Hereditary dz suspected: do a family tree.
• IBD.
• Gout.
• Rheumatoid arthritis.
• Osteoarthritis.
• Seronegatives: PAIR:
  • Psoriasis
  • Anklyosing
  • IBD-associated
  • Reiter's 

Social history

• Smoking: ever smokedhow many per dayfor how longtype [cigarettepipechew] (increases NSAIDrisk).
• Alcohol: do you drink. If yes: typehow muchhow often (fall riskincreases NSAID risk).
• Present occupation.
• Any other factors that you wish to mention?

Disability

• Who is with you there at home [important for managing daily activities].
• Describe your home: stairsif apartment what floorhandles (fall risk).
• Difficulties with cookingdressingbathing.
• How interrupts life.
• Home aidsutensilsappliances.

Drug history

• Prescriptions currently on [goldetc]noting side effects.
• Over-the-countersesp. NSAIDs.
• Steroids.
• Recreational drugs [most rheumatoid pt's are older than thisbut may usefor pain escape].
• Estrogen replacements [if menopausal]other hormones.
• Calcium supplements.
• Allergies: if allergic to drugmake sure not an allergynot just acommon side-effect.

Rheumatoid Exam »

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