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.
- Compare active, passive and resisted movement to distinguish articular restriction, contractile tissue pain and effort limited by pain or fear.
- Describe swelling as soft synovitis, effusion, bony enlargement, oedema or a focal mass rather than using the word 'swollen' without anatomy.
- Examine skin, nails, eyes, mouth, lymph nodes and relevant organ systems when inflammatory or connective-tissue disease is possible.
- Record function using concrete tasks—walking distance, stairs, dressing, grip, work and sleep—not only a numerical pain score.
- Consent, privacy, chaperone, communication support and pain-limited adaptation are part of examination accuracy and safety.
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.
Purpura with neuropathy, haematuria or proteinuria, hypoxia, severe cytopenia, myocarditis or new neurological dysfunction may indicate organ-threatening immune disease and requires urgent specialty assessment.
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.
- Summarise anatomy, inflammatory probability, systemic features and uncertainty; order only investigations that answer the resulting clinical questions.