Frank

A 52-year-old man presents with bilateral foot pain and left knee swelling 6 weeks after starting a new job requiring safety boots and ladder climbing. Sausage toes, nail changes and a morning-stiffness pattern raise the question of inflammatory arthritis. Take a focused musculoskeletal history, examine the joints and skin, and formulate a diagnosis and management plan.

1. 1Take a focused musculoskeletal history using SOCRATES
2. 2Characterise the morning stiffness and identify the inflammatory joint pattern
3. 3Screen for extra-articular features: skin, nails, eyes, GI tract
4. 4Take a relevant past, family, social and occupational history
5. 5Verbalise a joint and skin examination including all affected areas
6. 6Order targeted investigations to confirm the diagnosis
7. 7State a working diagnosis with relevant differentials
8. 8Formulate a management plan including analgesia, referral and lifestyle advice