MSK History

Question 1

Osteoarthritis

Answer 1

Mechanical wear and tear

Question 2

Gout

Answer 2

Hot and swollen

Question 3

RA

Answer 3

Worse in the morning

Question 4

Septic arthritis

Answer 4

Hot and swollen
Fever

Question 5

Osteoporosis

Answer 5

SHATTERED

Question 6

Psoriatic arthritis

Question 7

HPC: Site

Answer 7

What is the pattern of joint involvement?
- Which joints are affected?
- Small or large joints?
- One or more than one joint?
- Bilateral? Symmetrical or asymmetrical?

Question 8

HPC: Onset

Answer 8

When did it start?
Speed of onset?
Acute: gout
Subacute: septic arthritis, RA
Chronic: osteoarthritis
Constant since onset?
If episodic: frequency, regularity and duration?

Question 9

HPC: Character

Answer 9

Ache
Sharp pain
Throbbing

Question 10

HPC: Radiation

Answer 10

Examples:
Neck pain to upper limb
Lower back pain to buttocks
Hip pain to knee

Question 11

HPC: Associated symptoms

Answer 11

Stiffness and/or swelling
Crepitus (grating of surfaces against each other)
Erythema, increased local temperature
Fatigue, malaise, depression
Systemic temperature (gout, sepsis)
Rashes/skin conditions (psoriasis, erythema nodosum)
Nodules (RA, gouty tophi)
Fever, abdominal pain, weight loss (systemic symptoms of vasculitis or associated IBD)
Dry mouth, gritty eyes (sjogrens)

Question 12

HPC: Timing

Answer 12

What do your joints feel like when you get out of bed in the morning?
How do you feel at the end of the day?
How do you sleep?
RA: significant early morning stiffness (>60 mins usually) and joints stiffen up again after REST/in evening
OA: minimal to moderate early morning stiffness (<30 mins) and joints made worse after ACTIVITY and also stiffen up in the evening again

Question 13

HPC: Exacerbating factors

Answer 13

Exercise in mechanical/degenerative conditions
Rest in inflammatory conditions

Question 14

HPC: Alleviating factors

Answer 14

NSAIDs
Exercise/Rest

Question 15

HPC: Severity

Answer 15

Very severe - acute gout/sepsis
Slightly less severe - RA/OA
Any movements that are particularly painful?
Is function limited by pain?

Question 16

Completing questions

Answer 16

ASK ABOUT TRAUMA
Recent infective episodes?
Have you had anything similar previously? What tests, diagnoses and treatments have you had? How did you respond to those treatments?
Diabetes? (Predisposition to infection)
Psoriasis, IBD, Coeliac?
TB?
Autoimmune conditions (e.g. thyroid) increases other autoimmune e.g. RA/SLE
Risk factors for gout (alcohol intake, renal disease, low dose aspirin, diuretics, metabolic syndrome (HT, obesity, diabetes, vascular disease)

Question 17

Drug history

Answer 17

Current medication for presenting condition
Other current medication
Over the counter medication? Do they work?
Previous medication - did it work? Any side effects? Why was it changed?

Question 18

Social history

Answer 18

Occupation - does the problem affect their employment?
Sports and hobbies
Home circumstances - type (house, bungalow, dependents, carers, social support)
Ability to carry out ADLs - detailed history likely needed
Smoking
Alcohol

Question 19

Family history

Answer 19

RA
OA
Psoriasis
Gout
UC
Crohn’s
Connective tissue disease
Other autoimmune