What questions to ask a patient presenting with pyrexia, malaise, and arthralgia?

From the Guidelines

When evaluating a patient with fever, malaise, and joint pain, it is crucial to ask about the onset, duration, and pattern of fever, as well as the location and severity of joint pain, to differentiate between infectious causes, inflammatory conditions, and other systemic diseases, as suggested by the most recent guideline update 1. To guide the evaluation, consider the following key points:

• Inquire about recent travel history, tick or insect bites, new medications, and exposure to sick contacts to identify potential infectious causes.
• Ask about the patient's medical history, including autoimmune conditions, recent infections, or immunocompromising conditions, to assess the risk of inflammatory or immunological diseases.
• Determine if there's been any trauma, new sexual contacts, or intravenous drug use to consider other potential causes of joint pain and fever.
• The combination of fever with joint pain suggests systemic inflammation, and the pattern of symptoms often provides valuable diagnostic clues, as noted in the management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy 1.
• Also, ask about self-medication attempts and response to antipyretics or anti-inflammatories, as this information can guide immediate management while awaiting definitive diagnosis, and consider referral to rheumatology for further evaluation and management, as recommended by the European League Against Rheumatism 1. The most recent guideline update 1 provides a framework for managing immune-related adverse events, including joint pain and fever, and emphasizes the importance of careful evaluation and monitoring to guide treatment decisions. Some key questions to ask the patient include:
• Can you describe the onset and duration of your fever and joint pain?
• Have you recently traveled or been exposed to anyone with a similar illness?
• Have you experienced any trauma or injury that could be contributing to your joint pain?
• Have you noticed any other symptoms, such as rash, sore throat, or respiratory complaints?
• Have you tried any self-medication or treatments for your symptoms, and if so, what was the response? By asking these questions and considering the patient's medical history and potential risk factors, you can gather valuable information to guide the evaluation and management of the patient's condition, with the goal of improving morbidity, mortality, and quality of life outcomes.

From the Research

Patient Assessment

To evaluate a patient with fever, malaise, and joint pain, the following questions can be asked:

• What are the characteristics of the patient's pain (e.g., location, duration, severity, triggers, relieving factors) 2, 3?
• Are there any mechanical symptoms (e.g., locking, popping, giving way) 3?
• Is there joint effusion (e.g., timing, amount, recurrence) 3?
• What is the mechanism of injury (if applicable) 3?
• Are there any extra-articular manifestations (e.g., skin rashes, eye symptoms) 2?
• What is the pattern of joint involvement (e.g., single joint, multiple joints, symmetric, asymmetric) 2?
• Are there any systemic symptoms (e.g., fever, malaise, weight loss) 4?

Medical History

• What is the patient's medical history (e.g., previous joint problems, infections, autoimmune disorders) 2, 4?
• Are there any allergies or sensitivities to medications 5?
• What medications is the patient currently taking 5?

Physical Examination

• What are the findings on physical examination (e.g., joint tenderness, swelling, warmth, redness) 2, 3?
• Are there any signs of infection (e.g., fever, chills, sweating) 4?

Laboratory Tests

• What laboratory tests are indicated (e.g., complete blood count, erythrocyte sedimentation rate, C-reactive protein, blood cultures) 2, 4?
• Are there any rheumatologic laboratory tests that may be helpful in diagnosing the underlying condition 2?