Taking a complete history and performing a thorough physical
examination are the two most important "tests" that can be done to diagnose a
specific type of arthritis. Often neither laboratory testing nor X-rays are
necessary to reach a diagnosis if the history and physical exam are performed
properly. Only in certain cases may these further studies be needed to assess
the extent of the disease or to prepare for a treatment course.
Information your doctor will need from you
The most important information you can give your doctor is a clear
description of where (as in which joints are affected), when, and how the joint
problem began. Answer the following questions for yourself before your
visit:
- Was the problem preceded by another
illness?
- Were the symptoms acute, developing over a few days, or
more chronic (long term) in nature?
- Does the pain begin one place,
go away, and then reappear in another joint, or are all joints continuously
painful?
Other aspects of the joint problem that are important are the timing
of the discomfort and anything that makes the problem worse or better. Pain and
stiffness that is worse immediately upon arising but improves slowly as the day
goes on is suggestive of a process such as occurs in rheumatoid arthritis,
while brief stiffness after rest but greater discomfort following repetitive
movement may suggest osteoarthritis.
It is also important to evaluate the backdrop upon which these
symptoms are occurring. Systemic or whole-body symptoms such as fevers, sweats,
and weight loss suggest an entirely different disease process than isolated
joint-centered complaints. Because rheumatoid arthritis early on can mimic a
wide array of immune dysfunction-related syndromes, including
lupus, it is necessary to ask about symptoms such as
rash, abnormal hair loss, oral and genital ulcers, a history of seizure
disorder, psychiatric illness,
anemia or other cell count abnormalities, recurrent
chest pain, kidney dysfunction, prior episodes of blood clots in the legs or
lungs, hepatitis, redness of the eyes, weakness or loss of sensation, and
medication exposure. While it sounds like a laundry list, all aspects of your
health are important in determining the diagnosis, as are more obvious clues
such as your age and gender. Your health professional should take the time to
gather all of the pertinent clues to rank the possible disease processes by
likelihood, thus making decisions regarding "what next?" easier.
Physical examination
A good physical examination covers more than just the joints. Just
like the history taking, the physical exam should be methodical and complete.
People are always surprised when a
rheumatologist asks to see their skin, fingernails,
and mouth, but the diseases that cause joint pain and swelling are often
disorders that affect all of the body's systems. Besides the skin, hair, and
nails, time should be spent looking for enlarged lymph nodes in the neck,
armpits, and groin; listening to the lungs and heart; feeling the abdomen for
signs of an enlarged liver, spleen, or other mass; and neurological
dysfunction, such as focal muscle weakness or sensory loss. The importance of
the complete physical cannot be overemphasized.
Finally, all of the joints must be evaluated, including the neck and
spine, shoulders, elbows, wrists, fingers, hips, knees, ankles, and toes. When
evaluating the joints themselves, it is important that your health professional
assess the range of motion, degree of swelling (soft tissue versus bony),
tenderness, and presence of deformity. This establishes a baseline as well as
giving diagnostic information. The only reliable way to objectively assess
improvement or worsening of joint findings is to accurately document which
joints are diseased and in what manner, and for this purpose many doctors use a
joint diagram at each visit.
