As a physiotherapist, the most challenging part of my job is diagnosing conditions. When patients come to see me, the first question they want answered is usually “What’s going on with my back/ankle/knee?”
When it comes to identifying inflammatory arthritis, this is even more difficult due to our (minimal) level of training as well as the resources that are available to us.
Unlike our rheumatology colleagues, I cannot refer for blood tests to diagnose inflammatory arthritis and it is more difficult for me to refer for an MRI investigation as well.
I am lucky that at BJC Health I work with a group of rheumatologists who are always happy to speak with me about any challenging cases. But how else can I be more attentive with my assessment to give me clearer direction as to whether my patient could have inflammatory disease?
If I am suspicious that my patient has inflammatory arthritis, I can work with the rheumatologist to make this diagnosis. Over the years, I have learnt that there are simple questions that I can ask when I am recording patient history if I suspect my patient may have inflammatory arthritis. The clearer and more direct I can be with my questions, the clearer it will be whether a referral needs to be made to a rheumatologist to help diagnose and manage the suspected inflammatory arthritis.
There are five questions that are important to ask if I suspect inflammatory arthritis and these are:
1. “Have you had an inflamed eye, or uveitis/iritis before?”
2. “Do you have psoriasis?”
3. “Do you have inflammatory bowel disease?”
4. “Have you ever had a very swollen finger or toe, or sausage finger/toe?”
5. “Do you suffer from pains in your tendons, for example at your heel, Achilles or at your elbow?”
These questions help screen for what is known as extra-articular features of inflammatory arthritis.
Extra-articular features refers to symptoms of inflammatory arthritis that are occurring outside a joint.
As a physiotherapist, the sooner I can identify patients who may have inflammatory arthritis, the better directed their treatment can be.
The challenge as a physiotherapist often lies in becoming a more proficient diagnostician and prognostician.
If we can all become more vigilant with screening for suspected inflammatory arthritis, I believe it will only take our patient care to an even higher level.