Synopsis
Take a reproducible rheumatological history and perform a respectful screening and regional examination that defines anatomy, inflammation, systemic involvement, function and urgency before selecting investigations.
- Begin with onset, tempo, pain site, swelling, stiffness, night symptoms, triggers, function and systemic features; the patient's trajectory is often more discriminating than pain severity.
- Use a GALS-style screen—gait, arms, legs and spine—to identify regions requiring a detailed examination, but do not let a screen replace targeted assessment of the presenting problem.
- Look before touching: posture, aids, muscle bulk, scars, rash, psoriasis, nail disease, swelling and how the patient transfers provide high-value information.
Key red flags
Disproportionate pain, tense swelling, pallor, pulse change, progressive weakness or sensory loss requires immediate trauma, vascular or surgical escalation rather than completion of routine tests.
Investigation priorities
Identify gait, upper-limb, lower-limb and spinal abnormalities requiring regional examination.
Management branches
A new musculoskeletal complaint without current physiological instability.
- Take a timed history covering inflammation, distribution, systemic associations, function, medicines and red flags before selecting the depth of examination.
- Perform general inspection and a GALS-style screen, then examine abnormal and symptom-relevant regions with comparison, active, passive and resisted movement.