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JOINT SYMPTOMSRecognise the patient with a joint symptom needing urgent attention:Short history of single, warm swollen, extremely painful joint and:• Temperature ≥ 38ºC. If known with gout 89, otherwise refer same day.• Known haemophiliac – possible bleed into the joint• Trauma in the past 48 hoursRefer same day.Approach to the patient with a joint symptom not needing urgent attentionDo a musculoskeletal screen to check if problem is in the joint. Ask the patient to:• Place hands behind head; then behind back. Make a fist and open hand. Press palms together with elbows lifted.• Walk. Sit and stand up with arms folded.Able to do all actionscomfortably.Unable to do all actions comfortably.Recent trauma?Joint problemunlikelyNoAsk about duration of joint pain.Yes• If general bodypain 32.• If localised pain seerelevant page.Yes23< 8 weeksDoes patient have a genital discharge?NoPainful big toe, knee or ankle with warm red overlying skin?NoYes≥ 8 weeksChronic arthritis88• Rest and elevate joint.• Apply ice.• Apply pressure bandage.• Give ibuprofen 200mg 3 aday with food for 5 days.Avoid if peptic ulcer, asthma,hypertension, heart failure,kidney disease.• X-Ray to exclude fracture ifno better after 5 days.• Give ibuprofen 400mg 8hourly with food for up to 1month. Avoid if peptic ulcer,asthma, hypertension, heartfailure, kidney disease.• If status unknown test forHIV 60.• Review after 1 month,sooner if joint pain worsens.Acute gout likely• Might have had similarepisode previously.• For treatment of acutegout attack and routinegout care 89.If no better, refer to specialist.33