31st January 2024

History

Often, the diagnosis is clinical and based on a clear history; however, tests may be needed if there is doubt or atypical presentation. A good history should include some of the following questions: 

• When did the pain start?
• Over what time frame did the pain reach its maximal intensity?
• Is there any association with the time of day?
• Does the pain get better/ worse with movement?
• Are there any exacerbating or relieving factors?
• Have there been any previous flares of this type of joint pain?
• Is the pain associated with systemic illness- fever, dysuria, rigors, etc.? If the answer to these questions is ‘yes,’ it is essential to consider septic arthritis as a cause for the presentation and treat it appropriately- septic arthritis should be treated promptly with input from the orthopaedic team- if missed septic arthritis can lead to death.
•  Are there any other painful sites, e.g. tendons, eyes in uveitis? If uveitis is suspected, slit lamp examination should be performed and treated urgently to avoid visual loss.

In the case of an inflammatory joint pain, in addition to taking a full family and past medical history, an accurate sexual history helps to rule in or rule out reactive arthritis. Taking a sexual history requires a non-judgemental and sensitive approach. The following questions are important to ask:

• Are you sexually active? 
• Do you practise genital/ anal/ oral sex or a combination of these? This will aid sites for testing if needed.
• Ask about genital symptoms: 
  • Do you have any burning or stinging on passing urine?
  • Have you noticed any unusual discharge from the penis or any change to your normal discharge (in women)? 
  • Have you noticed any testicular pain?
  • Is there pain on intercourse (dyspareunia)? If so, where is the pain?
  • Have you noticed any bleeding between your periods (intermenstrual bleed)?
  • Have you ever been tested and/ or treated for a sexually transmitted infection in the past? If so, when?
  • Do you have a regular sexual partner? If not, then further questions related to contacts are needed, which can be done at GUM clinic.
  • Do you use barrier contraception- i.e. condoms or diaphragms?