What six questions to ask when obtaining a history from a patient with monoarticular arthritis?
a) What is the timing of onset?
• seconds to minutes: consider internal derangement, loose body, fracture/trauma.
• several hours to 2 days: consider infection, crystal diseases, inflammatory arthritis syndromes, and palindromic rheumatism.
• insidiously over weeks: consider indolent infections, osteoarthritis, tumor.
b) Is there a history of intravenous drug abuse, or recent infection of any kind? Consider infection.
c) Has the patient ever experienced prior episodes of acute joint pain and swelling? Consider crystal diseases most commonly, as well as other inflammatory arthritis syndromes.
d) Has the patient had symptoms such as a skin rash, low back pain, diarrhea, urethral discharge, ocular inflammation/irritation, or mouth sores? Consider a spondyloarthritis such as reactive arthritis, psoriatic arthritis, enteropathic arthritis, or ankylosing spondylitis.
e) Is there a history of a bleeding diathesis, or use of anticoagulants? Consider hemarthrosis.
f) Has the patient been treated with a prolonged course of glucocorticoids? Consider infection, avascular necrosis, and fragility fracture.