Ellen

A 44-year-old woman of mixed Caucasian/African background presents to the GP clinic with bilateral symmetric hand and foot pain, prolonged morning stiffness, and difficulty with daily activities. Take a focused history, perform a relevant joint examination, and formulate a management plan.

1. 1Take a focused history of the joint pain including SOCRATES and morning stiffness
2. 2Identify affirmative features suggesting rheumatoid arthritis (RA)
3. 3Explore relevant past medical, family, and social history
4. 4Verbalise a focused hand and foot examination
5. 5Order and justify appropriate investigations (RF, anti-CCP, ESR/CRP, X-rays)
6. 6Provide a working diagnosis with relevant differentials
7. 7Initiate appropriate management including DMARDs and lifestyle modification
8. 8Arrange specialist referral and follow-up