Synopsis
Convert a multi-joint complaint into a timed, anatomical and systemic phenotype, identify infection or organ-threatening disease, and refer persistent inflammatory arthritis before avoidable structural damage occurs.
- Oligoarthritis involves a small number of joints and polyarthritis a broader multi-joint pattern, but count swollen joints rather than relying on the patient's word 'all over'.
- Define onset, duration, symmetry, small- versus large-joint distribution, axial disease, enthesitis, dactylitis and whether inflammation is additive, migratory or episodic.
- Examine skin, scalp, nails, eyes, mouth, lymph nodes and relevant cardiopulmonary, abdominal and neurological systems because extra-articular findings often decide the differential.
Key red flags
Fever, rash, exposure, immunosuppression, endocarditis risk or one destructive joint among several painful joints raises infection and requires urgent cultures and sampling.
Investigation priorities
Confirm synovitis, define distribution and find disease-defining extra-articular features.
Management branches
Polyarthritis with fever, shock, focal hot joint, renal change, visual symptoms, neuropathy or cardiopulmonary involvement.
- Stabilise physiology, obtain blood cultures and organ-directed tests, and aspirate any disproportionately inflamed accessible joint before antimicrobial treatment when safely possible.
- Contact the appropriate acute specialty and rheumatology; begin sepsis or organ-protection treatment according to the responsible pathway rather than awaiting a complete antibody panel.