Diagnosis in suspected rheumatological disease

Musculoskeletal symptoms may be the sole presenting complaint of a rheumatological disease or may be a minor part of a presenting symptom complex. Determining whether or not these symptoms reflect serious pathology requiring specialist management relies on careful history taking and a thorough examination. The majority of rheumatic conditions are chronic, and a holistic approach to patient management is required to establish how the illness affects the physical and psychological functioning of the patient, and to explore how symptoms may be managed. In assessing the patient with musculoskeletal symptoms, the following questions must be considered. First, are the symptoms due to an inflammatory process or a non-inflammatory process? Second, do the symptoms reflect a primary rheumatological disease or are they secondary to another pathology (e.g. infection or malignancy)? Third, are the symptoms a complication of the disease or a complication of treatment? Fourth, is there evidence of non-articular disease, which may be relevant to diagnosis or management? This chapter focuses on how elements of the history and examination can help answer these questions.