Rheumatological / MSK Histories Flashcards
What acronym do you want to use for a rheum / MSK hx?
What questions do you want to ask for each?
Pain - SOCRATES
Rashes, skin lesions and nail changes -
-> Have they noticed any changes in them?
Immune
-> Systemic Sclerosis = CReST
-> SLE
-> Sjogren’s syndrome
Stiffness -
-> When is it worse?
-> how does it impact ADLs
Malignancy -
-> “Have you noticed any unintentional weight loss
recently?”
-> “Have you experienced any night sweats recently?”
-> “Have you noticed any change in your appetite?”
-> “Have you felt more tired recently?”
Swelling and sweats
-> “Have you noticed any swelling of your joints
recently?”
-> “Which joints have become swollen and when did
that start?”
-> “Is the joint swelling painful?”
-> “Does the joint swelling impact your daily activities?”
-> “Have you noticed any associated redness of skin
overlying the swollen joints?”
Using SOCRATES give the S for a rheum hx.
What is the pattern of joint involvement?
Which joints are affected?
Small or large joints?
One or more than one joint?
What was the speed of onset like?
Is the condition bilateral?
If so, is it symmetrical or asymmetrical?
Using SOCRATES give the O for a rheum hx.
When did it start?
What was the onset like?
-> Acute e.g. gout
-> Subacute e.g. septic arthritis / rheumatoid arthritis
-> Chronic e.g. osteoarthritis (OA))
Has it been constant since the onset?
If episodic, what are the frequency, regularity and duration of the episodes?
Using SOCRATES give the C for a rheum hx.
Ache
Sharp pain
Throbbing
Using SOCRATES give the R for a rheum hx.
Neck pain to upper limb
Lower back pain (LBP) to buttocks/ lower limb
Hip pain to knee
Using SOCRATES give the A for a rheum hx.
Stiffness and/or swelling
Crepitus (grating of surfaces against each other)
Erythema -> Increased local temperature
Fatigue / malaise / depression
Systemic temperature (e.g. gout, sepsis)
Rashes/skin conditions (e.g. psoriasis, erythema nodosum)
Nodules (e.g. rheumatoid nodules, gouty tophi)
Fever, abdominal pain, weight loss (e.g. systemic symptoms of vasculitis/connective tissue disease or symptoms suggestive of associated inflammatory bowel disease)
Dry mouth and gritty eyes
Using SOCRATES give the T for a rheum hx.
Is there a relationship with the time of day?
-> Ask: ‘What do your joints feel like on rising; How do
you feel at the end of the day? How do you
sleep?’
-> RA – significant early morning stiffness (>60 mins
usually) & joints stiffen up again after period of
rest/ in evening
-> OA – minimal to moderate early morning stiffness
(<30 mins usually) & joints made worse by activity.
Also stiffen up in evening.
Using SOCRATES give the E for a rheum hx.
(E) Exercise in mechanical/ degenerative conditions;
Rest in inflammatory conditions.
(R) NSAIDs / Exercise / Rest as above.
Using SOCRATES give the S for a rheum hx.
Very severe – acute gout +/- sepsis
Slightly less severe – RA/ OA (usually)
Any movements that are particularly painful?
Is function limited by pain?
What questions should you ask for SLE?
“Have you recently experienced any fevers or weight loss?”
“Do you have any aching in any of your joints or muscles?”
“Have you noticed any rashes or skin changes recently?”
“Have you noticed any blood or other changes in your urine?”
“Have you noticed any changes in your thoughts or mood?”
“Have you felt more short of breath recently?”
“Have you experienced any chest pain recently?”
“Have you felt more fatigued or found that you are
bruising more easily recently?”
What questions do you want to ask in the PMH section of a rheum/MSK hx?
Has the patient had anything similar previously?
What tests, diagnoses and treatments have they had and how did they respond to those treatments?
Previous medication? Did it work? Any side effects? Why was it changed?
Is there a history of trauma?
Has the patient had any recent infective episodes? Including dental or pharyngeal infection (risk of joint sepsis)
Does the patient have diabetes (predisposing them to infection e.g. septic arthritis)?
Does the patient have psoriasis, inflammatory bowel disease or coeliac disease?
Have they had tuberculosis?
Do they have any auto-immune conditions (e.g. thyroid disease)? (This increases their risk of developing an additional auto-immune disease such as RA/ SLE).
Do they have risk factors for gout (alcohol intake, renal disease, low dose aspirin, diuretics, metabolic syndrome [hypertension / obesity / diabetes / vascular disease])?
What questions do you want to ask in the DHx section of a rheum/MSK hx?
ALLERGIES
Current medication for the presenting condition
Other current medication
Over the counter medications?
Do they work?
SE?
Adherence?
What questions do you want to ask in the FHx section of a rheum/MSK hx?
RA
OA
Psoriasis
Gout
Ulcerative Colitis
Crohn’s disease
Connective tissue disease / any other autoimmune disease?
What questions do you want to ask in the SHx section of a rheum/MSK hx?
Occupation.
-> Does the problem affect their employment?
Sports and hobbies
Home circumstances (type of dwelling e.g. house, bungalow; dependents, carers, social support)
Ability to carry out ADLS – a detailed history is likely to be needed here.
Smoking
Alcohol consumption
