Hitchon C, El-Gabalawy H.
Canadian Journal of CME, 1997;9:95-106

The possible causes of musculoskeletal (MSK) complaints can include inflammatory and non-inflammatory disorders involving joints, bones and soft tissues. Given this, diagnosis and managing patients with MSK disorders can be frustrating. Patient history and the physical examination should determine whether the pain is osseous, muscular, articular or periarticular. To determine the presence of systemic illness asking the following questions need to be answered:

• What has been the onset and progression of symptoms?
  
• Is synovitis present?
  
• Is a systemic process occurring?
  

The key clinical features that need to be analyzed in order to make an accurate diagnosis are pain, swelling, stiffness, weakness and constitutional symptoms. Laboratory investigations should complement the clinical evaluation. Initial investigations include measuring hematologic, renal and hepatic function, the acute-phase response (APR) and a search for autoantibodies. Based on the patient history, clinical features and laboratory investigations, possible diagnoses to consider are inflammatory polyarthritis, inflammatory pauciarthritis and diffuse muscular pain, with and without weakness.