History and clinical examination of the patient helps the physician to identify the nature of problem and narrow down the possibilities of differential diagnoses.
Age
Certain diagnosis are more frequent in specific age groups. SLE, rheumatic fever, and Reiter’s syndrome are more common the young, whereas fibromyalgia is most common in middle age, and osteoarthritis and polymyalgia rheumatica in old age.
Sex
Some diseases are more common in a particular gender or race.
Gout and the spondyloarthropathies like ankylosing spondylitis, Reiter’s syndrome are more common in men, whereas rheumatoid arthritis and fibromyalgia are more common in women.
Race
Polymyalgia rheumatica, giant cell arteritis, and Wegener’s granulomatosis preferentially affect whites, whereas sarcoidosis and systemic lupus erythematosus are more common in blacks.
Family History
Familial aggregation occurs in some disorders, such as ankylosing spondylitis, gout, RA, and Heberden’s nodes of osteoarthritis.
Onset of The Disease
The onset of disorders such as septic arthritis and gout tends to be abrupt, whereas osteoarthritis, rheumatoid arthritis, and fibromyalgia may develop more indolently. In terms of evolution, disorders are classified as chronic i.e slow but present for a duration (e.g., osteoarthritis) and acute i.e abrupt.
Musculoskeletal disorders typically are called acute if they last less than 6 weeks and chronic if they last longer.
Acute arthroplathies tend to be infectious, crystal-induced, or reactive. Noninflammatory and immune-related arthritides, such as osteoarthritis and RA, respectively, are often chronic.
Duration
The duration of the patient’s complaints may alter the diagnostic considerations. For example, the musculoskeletal signs and symptoms of hepatitis B virus infection may be identical with those of early RA at the onset but rarely persist beyond 3 weeks.
Distribution of The Disease
The number and distribution of involved articulations should noted. Articular disorders are classified as
monarticular (one joint involved), oligoarticular or pauciarticular (two to three joints involved), or polyarticular (more than three joints involved).
Nonarticular disorders can be classified as either focal or widespread.
The clinical history should also identify precipitating events, such as trauma, drug administration, or antecedent or intercurrent illnesses, that may have contributed to the patient’s complaints. A thorough rheumatic review of systems may disclose associated features outside the musculoskeletal system and provide useful diagnostic information.
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