A lot of information can be gathered from your medical history, but a hands-on physical examination performed by your doctor is also necessary to check on your current health status. During the physical examination, your doctor will be looking for visible symptoms, checking your range of motion, and observing changes in symptoms since your last physical examination.

Visible Symptoms

Your doctor will be looking for visible evidence during the physical examination. You will be observed for signs and symptoms that point to arthritis, including:

• Redness around the joint

• Warmth near the joint

• Joint stiffness

• Joint tenderness

• Fluid on a joint

• Bumps or nodules

• Pattern of affected joints

• Fever

As physical evidence is gathered, your doctor will work on a differential diagnosis, pitting one possible diagnosis against another. More diagnostic tests may be ordered before the working diagnosis is established. Treatment is prescribed based on the working diagnosis.

The criteria for diagnosis varies for the different types of arthritis. Classification criteria for rheumatic diseases appears on the American College of Rheumatology Web site at www.rheumatology.org/ publications/classification/index.asp.

Range of Motion

During the physical examination, your doctor may check your range of motion to see how much deviation there is from the normal range of motion for a specific joint. Your doctor checks range of motion to assess limitation caused by existing joint damage or other symptoms such as joint swelling, muscle spasms, and pain associated with arthritis. It is also helpful to establish a baseline measurement so future improvement or decline in range of motion can be tracked.

Range of motion is measured using a goniometer. Several types of goniometers exist, but the most common is a 180-degree, double-armed goniometer. As your doctor checks your range of motion, the joint movements that will be observed include: flexion (bending), extension (straightening), abduction (moving out or away from midline of the body), and rotation.

Range of motion, if impaired, reduces the distance and direction you can move your joint. As arthritis limits range of motion, mobility and function can be affected. Preserving range of motion is one of the goals of arthritis treatment.

Observing Change in Symptoms

It is important to recognize and report any increase or decrease in the severity of arthritis symptoms. It's also important to let your doctor know about any new symptoms you have developed. Symptoms reflect disease activity and the effectiveness or ineffectiveness of your current treatment.

Since arthritis symptoms vary from patient to patient, your doctor will be monitoring your individual progress. If you think of symptoms as indicators, it will help you convey changes in symptoms to your doctor. Your specific indicators will help you and your doctor make decisions about your treatment plan.

It's also useful to convey what you may have done to cause a change in symptoms. Try to answer these questions:

• What activity caused your joint to swell?

• What did you do to relieve the swelling?

• What activity may have caused your joint to stiffen?

• What, if anything, relieved the stiffness?

• What caused your pain level to increase?

• What relieves your pain and makes it tolerable?

• Is the stiffness worse in the morning?

• How long does it take to achieve maximum improvement?

• Do your symptoms get worse or better with activity?

Don't forget, it's just as important to disclose symptoms that have improved as symptoms that have worsened. Symptoms that have improved confirm that your treatment plan is working; the opposite can be said of worsening symptoms. The observations of doctor and patient are both relevant and form the foundation for making future decisions about your treatment goals.