10 minute consultation: Polyarthralgia
A 45 year old woman says she has had joint pains in her hands, knees, and hips for three months. Her symptoms have progressively worsened. Jo Samanta, Julia Kendall and Ash Samanta take you through a common condition in primary care patients with painful joints
Assessment--Is her joint pain simple arthralgia, degenerative joint disease, or an inflammatory arthropathy, or is it secondary to some other cause?
History--Ask whether she has had any swelling around the joints, morning stiffness, nocturnal pain or pain at rest, or recent viral or throat infection. Check for systemic features such as fever, weight loss, or fatigue. She may have bowel or bladder symptoms, and her eyes or skin may be affected. Is there a family history of rheumatoid arthritis? Other features may be prolonged repetitive use of hands; mood changes, altered sleep pattern, or lack of energy; and use of over the counter drugs or complementary treatment.
Examination--Which joints are affected? Check for symmetrical presentation and proximal interphalangeal or metacarpophalangeal joint swelling (absence of groove between knuckles on making a fist); inflammation and range of movement of joints; hand function, assessed by grip strength and ability to hold objects or