In many cases of early arthritis, a specific diagnosis is not possible at presentation and the clinical picture emerges over time. Accurate history, examination and rational investigation are crucial in narrowing the broad list of differential diagnoses. For patients with confirmed rheumatoid arthritis, prompt initiation of therapy will lead to greatly improved outcomes.
- Accurate diagnosis in a patient presenting with joint pain is dependent on thorough history and examination, focusing on the cardinal features of possible causes.
- Early initiation of corticosteroids can be considered in some circumstances, but may obscure subsequent clinical assessment by a second practitioner.
- If symptoms persist, referral to a rheumatologist within six weeks (if seropositive), or up to 12 weeks (if seronegative), is imperative.
- Referral to an emergency department for urgent assessment of possible septic arthritis is appropriate, or if there are worrying abnormalities in the vital observations (e.g. tachycardia, fever, hypotension, hypoxia).