Gender

Gout, reactive arthritis and ankylosing spondylitis are more common in men. Rheumatoid arthritis and other autoimmune connective tissue diseases are more common in women.

Age

• Is the person young, middle-aged or older? Injury is common in young people but can occur at any age.
• How old was the patient when the problem first started? Osteoarthritis and polymyalgia rheumatica rarely affect the under-fifties. Rheumatoid arthritis starts most commonly in women aged 20-50 years.

General health

• Is there any associated ill-health or other worrying feature, such as weight loss or fever? Systemic illness is a common feature of many rheumatic diseases. If there is weight loss and/or fever, think of autoimmune rheumatic disease, sepsis (joint infection may be due to septicaemia and is a medical emergency) or malignancy.
• Are there other associated medical conditions that may be relevant? Psoriasis or inflammatory bowel disease is associated with asymmetrical arthritis. Charcot’s joints are seen in diabetics.

Medication

Could a drug be a cause? Diuretics may precipitate gout in men and older women. Hormone replacement therapy or the oral contraceptive pill may precipitate systemic lupus erythematosus (SLE). Steroids can cause avascular necrosis. Some drugs cause a lupus-like syndrome.

Race

Is this relevant? Sickle cell disease causes joint pain in young black Africans, but osteoporosis is uncommon in older black Africans.

Past history

Have there been any similar episodes or is this the first? Are there any clues from previous medical conditions? Gout is recurrent; the episodes settle without treatment in about 10 days. Acute episodes of palindromic rheumatism may predate the onset of rheumatoid arthritis.

Family history

Does anyone in the family have a similar problem or another related disorder? Osteoarthritis may be familial. Sero-negative spondyloarthropathies is seen in families with a history of arthritis, psoriasis, ankylosing spondylitis, iritis or inflammatory bowel disease. Autoimmunity has a familial tendency.

Occupational history

What job does the patient do? This can be a factor in soft tissue problems and osteoarthritis (e.g. in heavy labourers and dancers). Work-related problems are becoming more common and are complained of more.

Psychosocial history

• Has there been an injury for which a legal case for compensation is pending?
• Has there been any recent major stress in family or working life? Could this be relevant? Stress rarely causes rheumatic disease but may precipitate a flare-up of inflammatory arthritis. Stress also tends to reduce a person’s ability to cope with pain or disability. Remember that the diagnosis of a chronic arthritis has a major influence on the lifestyle of patients and their families. The extent of disability should be noted.

3 Comments »

1. [...] which is often confused with palindromic rheumatism. Some of pain, swelling, warmth, and pain. …Health Nova: Your Ultimate Medical Portal Other factors of …Acute episodes of palindromic rheumatism may predate the onset of rheumatoid arthritis. … [...]

   Pingback by palindromic arthritis — April 5, 2010 @ 4:06 am

2. 

   the redness and itchiness of Psoriasis can be relieved easily by corticosteroids.:~:

   Comment by Andrew Jackson — May 3, 2010 @ 7:45 pm

3. 

   my friend is a Psoriasis sufferer for several years and there seems to be no permanent cure for it. .;

   Comment by Emma Johnson — May 6, 2010 @ 7:49 am

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