Rapid review: musculoskeletal and rheumatology

• This page is a revision tool, not a first introduction. Each block states the presenting picture, the single most likely diagnosis, the best first test, the best first treatment, the commonest wrong answer, and the full topic to read.
• Separate inflammatory, infectious, mechanical, neurological and malignant disease before naming a diagnosis. Guessing the diagnosis before deciding the family is the commonest error.
• The emergencies that must not be missed are a hot joint, rapidly progressing weakness, cord compression, suspected vasculitis with visual symptoms, compartment syndrome and a child with a septic hip.
• Many common problems are clinical diagnoses, but synovial aspiration, imaging and bone density still change management: a red, hot joint is infection until proved otherwise, a new vertebral fracture or resting bone pain needs malignancy excluded, and osteoporosis is a fracture-risk diagnosis rather than a cosmetic one.
• This is a curriculum-gap revision page with no single paired chapter in the source syllabus and no book pages or covers; each block links to the full MedGrasp topic that carries the depth, evidence and monitoring detail.

By the end of this page you should be able to:

1. Run through the presenting illnesses of musculoskeletal and rheumatology medicine in examination order, naming the likely diagnosis, first test, first treatment and common trap in each.
2. Spot the red flags that turn a routine presentation into an emergency.
3. Use the flowchart to decide whether a patient needs urgent aspiration, urgent imaging, urgent referral or careful outpatient review.
4. Move from each block to the full MedGrasp topic for depth on pathophysiology, criteria, doses and monitoring.

Musculoskeletal presentations fall into a small number of families: a single hot joint, regional pain, inflammatory polyarthritis, connective tissue disease, systemic vasculitis, a bone lesion or pathological fracture, fragility fracture and osteoporosis, and orthopaedic problems in children. The blocks below take each family in turn and give the answer that an examiner or a busy clinician wants first.

This page builds only on the full topics already held in MedGrasp, so book_pages and covers stay empty. Guideline editions in force here are NICE NG59 (last updated 29 July 2026) for low back pain and sciatica, NICE NG219 (published 9 June 2022) for gout, NICE NG100 (last updated 12 October 2020) for rheumatoid arthritis, the EULAR 2023 update of the systemic lupus erythematosus recommendations summarised in Kostopoulou M, Mukhtyar CB, et al. (2024), the Endocrine Society osteoporosis resources (19 February 2020), NICE NG12 (last updated 15 April 2026) for suspected cancer pathways, and NICE NG37 (last updated 23 November 2022) for complex fractures. ^{[1][2][3][4][5][6][7]}

A short list of tests does most of the work, and most are cheap.

• History and examination come first. Pain pattern, morning stiffness, systemic features, joint distribution and mechanical versus inflammatory behaviour matter more than any single blood test.
• Joint aspiration and synovial fluid analysis are the single most useful test in a hot joint: Gram stain, culture, crystals and cell count. A negative Gram stain does not exclude septic arthritis.
• Radiographs are essential for trauma, suspected fracture, bone lesion and structural damage. Normal early films do not exclude scaphoid fracture, stress fracture or early infection.
• Inflammatory markers (ESR, CRP) separate inflammatory from mechanical disease and monitor response but are not diagnostic on their own.
• Autoantibodies are interpreted with the clinical picture: rheumatoid factor and anti-CCP for rheumatoid arthritis, ANA with specific extractable nuclear antigen antibodies for connective tissue disease, ANCA for vasculitis.
• Ultrasound and MRI answer questions that radiographs cannot: synovitis, rotator cuff, occult fracture, marrow oedema and spinal canal compromise.
• Bone density (DXA) turns osteoporosis from a guess into a fracture-risk management plan.
• Urgent imaging is reserved for the right questions: spinal MRI for cord or cauda equina compression, CT for complex trauma, and specialist imaging pathways for suspected bone sarcoma.

The commonest error is to treat pain before deciding whether it is inflammatory, infectious, mechanical, malignant or neuropathic. The flowchart keeps the decisions in order.

• A single hot, red, exquisitely tender joint with systemic features: septic arthritis until proved otherwise.
• New neurological deficit, saddle anaesthesia or urinary retention in back pain: possible cauda equina syndrome.
• Back pain in a person with known cancer, weight loss, night pain or rest pain: possible metastatic disease.
• Visual symptoms, jaw claudication or scalp tenderness in an older adult: possible giant cell arteritis.
• Pain out of proportion, pain on passive stretch, tense swelling or neurological change after injury or exertion: possible compartment syndrome.
• A non-healing fracture, pathological fracture or bone pain at rest: possible bone tumour (primary or metastatic).
• Delayed development, limp or deformity in a child: possible hip, spine or metabolic bone disease.

Presenting picture: a single joint that is swollen, hot, red and too painful to move, often with fever or systemic upset. The knee is the commonest site, but any joint can be involved.

Single most likely diagnosis: septic arthritis in any patient with fever, immunosuppression, a prosthetic joint or a source of bacteraemia; gout in an adult with podagra or a previous flare; pseudogout in an older adult, often after a minor illness or procedure.

Best first test: synovial fluid aspiration before antibiotics whenever possible, for Gram stain, culture and polarised-light microscopy for crystals. Blood cultures and inflammatory markers in parallel.

Best first treatment: for suspected septic arthritis, urgent washout (surgical or arthroscopic) plus intravenous antibiotics according to local sepsis pathways, followed by targeted therapy. For an acute gout flare, a first-line option is an NSAID, colchicine or a short course of an oral corticosteroid, taking comorbidities and preferences into account, per NICE NG219. ^[2] For pseudogout, aspiration for relief plus an NSAID, colchicine or intra-articular or short-course oral corticosteroid.

Commonest wrong answer: sending a patient away with "gout" and oral NSAIDs without aspirating the joint; or treating septic arthritis only with antibiotics and no drainage.

Full topics: infectious-disease/septic-arthritis; musculoskeletal/gout-and-pseudogout; musculoskeletal/joint-examination-and-approach-to-joint-pain. ^[2]

Presenting picture: low back pain with or without sciatica. The decision is not the precise disc level but whether the pain is mechanical, inflammatory, neurological or sinister.

Single most likely diagnosis: non-specific mechanical low back pain when there are no red flags; nerve root compression or spinal stenosis when pain radiates below the knee with neurological signs; ankylosing spondylitis when a young adult has inflammatory back pain, morning stiffness and improvement with exercise.

Best first test: a careful neurological examination and screening for red flags first. NICE NG59 advises against routine imaging for non-specific low back pain. MRI of the lumbar spine is reserved for suspected cauda equina syndrome, progressive neurological deficit, suspected fracture, malignancy, infection, or pain that persists and might change management. ^[1]

Best first treatment: advice to stay active, simple analgesia and self-management for non-specific pain; epidural or surgical pathways for confirmed nerve root compression or stenosis that does not settle; NSAIDs and targeted physiotherapy for inflammatory back pain, with biologic referral for confirmed axial spondyloarthritis.

Commonest wrong answer: ordering an MRI for every patient with back pain, or missing cauda equina syndrome because the pain is labelled "just lumbago."

Full topics: musculoskeletal/low-back-pain-disc-herniation-and-spinal-stenosis; musculoskeletal/spondyloarthritis-and-ankylosing-spondylitis. ^[1]

Red flags for back pain include trauma, history of cancer, systemic steroids, drug misuse, HIV, unintentional weight loss, progressive neurological deficit, saddle anaesthesia, bladder or bowel dysfunction, thoracic pain, and pain that is severe, unremitting or worse at night. Suspected cauda equina syndrome is a surgical emergency.

Presenting picture: joint swelling, prolonged morning stiffness, warmth and symmetrical or axial involvement. The history and distribution matter more than any single blood test.

Single most likely diagnosis: rheumatoid arthritis when small joints of the hands and feet are swollen symmetrically with raised inflammatory markers; axial spondyloarthritis or ankylosing spondylitis when young adults have inflammatory back pain and sacroiliac tenderness; osteoarthritis when pain is worse with use and better with rest, with bony enlargement rather than soft tissue swelling. Psoriatic arthritis and the other spondyloarthritides are diagnosed by pattern, skin, nail and enthesial clues.

Best first test: joint examination, inflammatory markers and targeted autoantibodies. For possible rheumatoid arthritis: rheumatoid factor and anti-CCP testing plus baseline radiographs of hands and feet. For possible axial disease: AP pelvis radiograph, or MRI of the sacroiliac joints when radiographs are normal, and HLA-B27 in the appropriate clinical context. NICE NG100 recommends urgent referral when inflammatory arthritis is suspected. ^[3]

Best first treatment: for rheumatoid arthritis, early DMARD therapy (typically methotrexate with folic acid), escalating to combination therapy and, if targets are not met, biologic or JAK inhibitor therapy, with a treat-to-target approach. For axial spondyloarthritis, regular NSAIDs, exercise and physiotherapy, then TNF or IL-17 inhibition for active disease. For osteoarthritis, education, weight loss, exercise, topical then oral analgesia, and joint replacement at end stage.

Commonest wrong answer: waiting for radiographic erosions before starting DMARDs in rheumatoid arthritis, or prescribing repeated NSAIDs for inflammatory back pain that is clearly spondyloarthritis.

Full topics: musculoskeletal/rheumatoid-arthritis; musculoskeletal/spondyloarthritis-and-ankylosing-spondylitis; musculoskeletal/osteoarthritis; musculoskeletal/juvenile-idiopathic-arthritis-and-paediatric-rheumatology. ^[3]

NICE NG100 gives the framework for rheumatoid arthritis in adults: diagnosis in specialist care, early DMARD therapy, monthly disease activity monitoring (CRP and a composite score such as DAS28) until remission or low activity is reached, biologic selection after failure of optimised conventional DMARDs, and routine screening for tuberculosis and hepatitis before biologics. ^[3]

Presenting picture: multi-system disease in a young woman. Rashes, photosensitivity, oral ulcers, arthritis, serositis, nephritis or neuropsychiatric features suggest systemic lupus erythematosus. Raynaud phenomenon, skin thickening of fingers, oesophageal dysmotility, lung fibrosis or renal crisis suggest systemic sclerosis. Overlap features are common.

Single most likely diagnosis: systemic lupus erythematosus when ACR/EULAR 2019 criteria are met and organ involvement is confirmed; systemic sclerosis when skin thickening proximal to the metacarpophalangeal joints or a characteristic antibody pattern is present; polymyositis or dermatomyositis when proximal weakness and a rash are present.

Best first test: organ-directed assessment rather than a single screen: urinalysis and renal function, complement, anti-dsDNA and other specific antibodies, and assessment of skin, joints, lungs and heart. For systemic sclerosis, the ACR/EULAR 2013 criteria score and antibody panel guide classification.

Best first treatment: for systemic lupus erythematosus, hydroxychloroquine for all patients (about 5 mg/kg real body weight per day), glucocorticoids at the lowest effective dose, and immunosuppression (mycophenolate, azathioprine) for organ-threatening disease; the EULAR 2023 update emphasises a treatment target of remission or low disease activity and careful glucocorticoid withdrawal when stable. ^[4] For systemic sclerosis, EULAR 2023 supports up-front combination therapy (a phosphodiesterase-5 inhibitor plus an endothelin receptor antagonist) for associated pulmonary arterial hypertension, and mycophenolate for skin fibrosis and interstitial lung disease.

Commonest wrong answer: treating lupus or scleroderma only on antibody results without confirming organ involvement, or stopping hydroxychloroquine abruptly because of fear of toxicity.

Full topics: musculoskeletal/systemic-lupus-erythematosus; musculoskeletal/systemic-sclerosis; musculoskeletal/polymyositis-dermatomyositis-and-sjogren-syndrome; musculoskeletal/antiphospholipid-syndrome-and-overlap-connective-tissue-disease. ^[4]

For systemic lupus erythematosus, the systematic review that informed the EULAR 2023 update found that the recommended hydroxychloroquine dose of 5 mg/kg was based on observational studies calculating a threshold for increased flare risk near 5 mg/kg per day, and on older evidence of good quality suggesting that toxicity risk is low at doses below that figure. ^[4]

Presenting picture: a systemic inflammatory illness with organ ischaemia or inflammation. Giant cell arteritis presents in older adults with new headache, scalp tenderness, jaw claudication or visual symptoms. ANCA-associated vasculitis presents with renal, pulmonary, ear, nose, throat or neurological disease. Behcet disease presents with oral and genital ulcers, uveitis and vascular events.

Single most likely diagnosis: giant cell arteritis in an older adult with a compatible headache or visual disturbance; ANCA-associated vasculitis when microscopic haematuria, red cell casts or systemic features accompany organ involvement; IgA vasculitis (Henoch-Schonlein) in a child with palpable purpura and arthritis.

Best first test: for suspected giant cell arteritis, inflammatory markers and urgent temporal artery biopsy or vascular imaging; do not delay treatment while arranging biopsy if vision is threatened. For ANCA-associated vasculitis, urine microscopy, renal function, ANCA testing, chest imaging and tissue biopsy where possible.

Best first treatment: for giant cell arteritis, high-dose glucocorticoids immediately to protect vision, with taper guided by symptoms and inflammatory markers, and tocilizumab where indicated by specialist advice. For ANCA-associated vasculitis, remission induction with glucocorticoids plus cyclophosphamide or rituximab (rituximab is preferred for relapsing disease or when cyclophosphamide is undesirable). For Behcet disease, colchicine for mucocutaneous disease with escalation for sight-threatening or vascular disease.

Commonest wrong answer: waiting for biopsy before starting steroids in threatened-vision giant cell arteritis, or treating an unwell patient with a positive ANCA as infection without checking urine and renal function.

Full topics: musculoskeletal/giant-cell-arteritis-and-polymyalgia-rheumatica; musculoskeletal/vasculitis-anca-and-medium-vessel; pediatrics/iga-vasculitis-and-psgn. ^[6]

Polymyalgia rheumatica commonly presents in older adults with bilateral shoulder and hip girdle pain and stiffness and a raised ESR. The distinction from elderly-onset rheumatoid arthritis and other inflammatory disease rests on pattern, normal creatine kinase and a rapid steroid response, with temporal artery assessment when giant cell arteritis cannot be excluded.

Presenting picture: persistent bone pain at rest or at night, a palpable mass, pathological fracture after minimal trauma, or an incidental lesion on imaging. Children and young adults present differently from older adults.

Single most likely diagnosis: a benign bone lesion or non-neoplastic mimic in many incidental findings; primary bone sarcoma (osteosarcoma, Ewing sarcoma, chondrosarcoma) in children, adolescents and young adults; metastatic disease from breast, prostate, lung, kidney or thyroid in older adults.

Best first test: plain radiograph of the lesion, then MRI for local staging. NICE NG12 supports suspected cancer pathway referral when an X-ray suggests possible bone sarcoma, with very urgent assessment (within 48 hours) for children and young people, and a very urgent direct-access X-ray for unexplained bone swelling or pain in children and young people. ^[6]

Best first treatment: do not biopsy or operate outside a specialist sarcoma service. Benign and low-grade lesions may be observed or curetted; bone sarcomas need neoadjuvant chemotherapy plus wide surgical resection plus adjuvant therapy in a specialist centre. Bone metastases are managed by treating the primary cancer, with bone-targeted agents, radiotherapy and surgical stabilisation as indicated.

Commonest wrong answer: performing an unplanned excision or lesional biopsy before staging, or assuming a painful bone in an older adult is "arthritis" without a radiograph.

Full topics: musculoskeletal/primary-bone-tumours-in-adults; musculoskeletal/soft-tissue-sarcoma; musculoskeletal/bone-metastases-and-pathological-fracture; pediatrics/childhood-bone-tumours. ^[6]

The current WHO classification is the 5th edition of tumours of soft tissue and bone (2020), and NICE NG12, last updated 15 April 2026, keeps referral guidance current. ^[6]

Presenting picture: trauma with deformity, swelling, bruising, inability to bear weight or move the limb, neurological or vascular change, or severe pain that is out of proportion and worsening.

Single most likely diagnosis: a simple fracture when mechanism and tenderness fit a single bone; multiple or open fractures after high-energy trauma; acute compartment syndrome when pain is escalating, especially pain on passive stretch, with tense swelling or sensory change.

Best first test: radiographs in two planes; CT for complex articular, pelvic or spinal injuries. Do not wait for imaging if compartment syndrome is suspected clinically. NICE NG37 covers complex fractures (pelvic, open and severe ankle fractures) in pre-hospital and hospital settings. ^[7]

Best first treatment: analgesia, splintage, neurovascular reassessment and reduction of displaced or neurovascularly compromised fractures; open fractures need antibiotics, tetanus update and urgent surgical debridement and stabilisation in a major trauma setting per NICE NG37. Acute compartment syndrome needs urgent fasciotomy to decompress all affected compartments; delayed fasciotomy risks permanent damage.

Commonest wrong answer: relying on a Doppler pulse to exclude compartment syndrome, or applying a tight circumferential cast without reassessment after reduction.

Full topics: musculoskeletal/adult-orthopaedic-injuries; musculoskeletal/compartment-syndrome; emergency-medicine/fracture-principles-open-fractures-compartment-syndrome; emergency-medicine/long-bone-fractures-fat-embolism-and-dislocations; emergency-medicine/pelvic-and-hip-fractures. ^[7]

Acute compartment syndrome is a clinical diagnosis. Early signs are pain out of proportion, pain on passive stretch and sensory change; pulselessness and pallor are late. Measurement of compartment pressure may help when the diagnosis is uncertain, but treatment should not be delayed when the clinical picture is clear.

Presenting picture: often no symptoms at all until a fragility fracture (vertebral, hip, wrist) after a fall from standing height or less. Back pain, height loss or kyphosis may signal vertebral fractures.

Single most likely diagnosis: osteoporosis when a fragility fracture has occurred, or when bone mineral density by DXA meets the diagnostic threshold in the presence of risk factors. Low bone mass with high fracture risk is managed pharmacologically in modern practice.

Best first test: DXA of lumbar spine and hip, plus fracture-risk estimation (FRAX or equivalent), and screening for secondary causes (vitamin D, renal function, calcium, tests for malabsorption, myeloma and endocrinopathy as indicated).

Best first treatment: non-pharmacological prevention and falls reduction for all; anti-resorptive therapy (bisphosphonates first line) for women at high fracture risk, with reassessment after 3 to 5 years and a bisphosphonate holiday for low-to-moderate risk patients; anabolic therapy (teriparatide or abaloparatide) for very high-risk patients, followed by an antiresorptive; calcium and vitamin D with any treatment other than anabolic therapy. The Endocrine Society 2020 resources support this hierarchy, and modern care uses the same principles. ^[5]

Commonest wrong answer: treating a single low BMD result without fracture-risk context or falls prevention, or stopping a bisphosphonate without a holiday plan and reassessment.

Full topic: endocrinology/osteoporosis. ^[5]

Presenting picture: a child or adolescent with a limp, refusal to bear weight, deformity, leg-length discrepancy, scoliosis or a swollen joint. The differential is broad and changes by age.

Single most likely diagnosis: by age and presentation: a limping toddler may have transient synovitis or septic arthritis (fever and inability to bear weight favour infection); a school-age child with a painless limp may have Legg-Calve-Perthes disease; an adolescent with slipped capital femoral epiphysis is typically overweight with a painful, externally rotated leg. Developmental dysplasia of the hip presents in the neonate with hip instability; clubfoot is a congenital foot deformity; scoliosis is usually idiopathic.

Best first test: clinical hip examination in the neonate (Barlow and Ortolani), plain radiographs for suspected hip, spine or limb disease, and ultrasound for the neonatal hip when indicated. ESR, CRP and aspiration are essential if septic arthritis or osteomyelitis is possible.

Best first treatment: by diagnosis: neonatal hip instability with a Pavlik harness; clubfoot with the Ponseti method; Perthes disease with containment principles; slipped capital femoral epiphysis with urgent surgical pinning in situ; septic arthritis with urgent drainage and antibiotics; transient synovitis with rest and observation.

Commonest wrong answer: missing a septic hip in a child with a limp, or reducing a slipped capital femoral epiphysis before imaging and specialist review.

Full topics: pediatrics/paediatric-orthopaedic-injuries; pediatrics/developmental-dysplasia-of-the-hip; pediatrics/leg-calve-perthes-disease; pediatrics/slipped-capital-femoral-epiphysis; pediatrics/scoliosis; pediatrics/clubfoot-and-metatarsus-adductus. ^{[6] [7]}

Children's orthopaedic problems are time-critical: a septic hip can destroy cartilage within hours, and an unstable slipped capital femoral epiphysis can compromise the femoral head. When the diagnosis is unclear, lean towards urgent specialist review and imaging.

• Radiographs are first-line for trauma, suspected lesion and established structural disease. Normal early films do not exclude scaphoid fracture, stress fracture, septic arthritis or avascular necrosis.
• Advanced imaging: MRI shows marrow oedema, occult fracture, synovitis and soft tissue; CT defines complex articular and pelvic injuries; ultrasound is excellent for real-time soft-tissue and guided procedures.
• Joint aspiration decides the hot joint. Send fluid for culture, Gram stain and polarised-light microscopy; crystal interpretation follows shape and birefringence.
• Autoantibody panels: anti-CCP is more specific than rheumatoid factor in synovitis; ANA is a screening test and specific antibodies matter only when the clinical picture fits.
• Inflammatory markers: ESR and CRP support inflammatory disease and monitor response, but both are non-specific.
• Bone density: T-scores in postmenopausal adults and older men, Z-scores in younger patients; diagnosis and treatment decisions use fracture-risk tools and context rather than T-scores alone.
• Nerve studies localise entrapment and neuromuscular disease.
• Biopsy: a specialist decision after imaging, performed by the team that will treat the lesion, using an excisable tract.

• Methotrexate: taken once weekly, with daily folic acid on a separate day; monitor full blood count and liver function; avoid in pregnancy and severe renal impairment.
• Biologics and JAK inhibitors: screen for tuberculosis, hepatitis B and C, and significant active infection before starting; avoid live vaccines around therapy.
• Hydroxychloroquine: cornerstone of systemic lupus erythematosus care at about 5 mg/kg real body weight per day, with ophthalmological review for long-term safety.
• Allopurinol: a urate-lowering drug started after an acute flare has settled, with low starting doses, prophylaxis against early flares, and titration against serum urate.
• NSAIDs: useful for gout flares, spondyloarthritis and pain, but renal, cardiovascular and gastrointestinal risks limit use in older adults and those with hypertension or chronic kidney disease.
• Glucocorticoids: life-saving in giant cell arteritis and useful in many autoimmune diseases; dose and duration should be the lowest that controls disease.
• Bisphosphonates: first-line for osteoporosis at high fracture risk, with reassessment after 3 to 5 years and a bisphosphonate holiday for low-to-moderate risk patients; ensure calcium, vitamin D and adequate renal function.
• Intra-articular injection: useful in selected joints, but never inject an infected joint.
• Compartment syndrome: once suspected, urgent surgical decompression is required; analgesia and elevation do not replace fasciotomy.

• Shoulder pain: rotator cuff disease causes painful abduction and night pain; frozen shoulder causes capsular restriction; acromioclavicular joint pain is local; referred neck pain moves with neck motion. Red flags are mass, systemic symptoms and neurological signs.
• Knee pain: patellofemoral pain is anterior and worse on stairs; meniscal tears cause clicking, locking and joint-line tenderness; ligament injuries follow a mechanism with instability; osteoarthritis causes activity-related pain and bony enlargement.
• Hip pain: groin pain suggests hip joint disease; lateral pain suggests greater trochanteric pain syndrome; posterior pain may be sacroiliac or lumbar in origin. In children, hip and knee pain may reflect proximal hip disease.
• Heel pain: plantar fasciitis causes first-step morning pain; Achilles tendinopathy causes posterior heel pain on loading; a calcaneal stress fracture follows a change in training. Spondyloarthritis can present as enthesitis.
• Neck and widespread pain: most neck pain is mechanical; neurological symptoms, gait change or hand clumsiness need urgent assessment. Widespread pain with sleep disturbance and normal investigations may be fibromyalgia, diagnosed by pattern and exclusion.

• Same day or emergency: hot joint with systemic features, cauda equina syndrome, threatened vision in suspected giant cell arteritis, acute compartment syndrome, open fracture, septic hip in a child, unstable or displaced fracture with neurovascular compromise.
• Urgent (days): suspected bone sarcoma or soft tissue mass with concerning features, rapidly progressive weakness, new inflammatory arthritis with raised markers, pathological fracture, suspected slipped capital femoral epiphysis or Perthes disease in a limping child.
• Routine specialist: persistent inflammatory back pain, complex soft tissue or joint injury, advice on DMARD or biologic therapy, osteoporosis with recurrent fractures despite treatment, difficult or recurrent crystal disease.
• Keep in primary care: most non-specific back pain, osteoarthritis, regional soft tissue pain, chronic widespread pain, and stable mechanical problems, with clear safety-netting for red flags.

• Do not equate a normal C-reactive protein with absence of serious disease.
• Do not label chronic widespread pain as fibromyalgia without excluding thyroid disease, inflammatory arthritis, vitamin D deficiency, sleep apnoea, and considering mental health and social context.
• Do not manage osteoporosis with drugs alone: fracture reduction also needs calcium, vitamin D, falls assessment, strength training and weight-bearing exercise.
• Do not reassure a patient with a swollen single joint and no fever that it is gout; infection can be afebrile.
• Do not forget that back pain with bilateral leg symptoms, perineal numbness or urinary retention is cauda equina syndrome until excluded.
• Do not assume pseudogout is harmless: it can precipitate in hospital, associate with metabolic and endocrine disease, and cause severe systemic flares.
• Do not start a biologic for inflammatory arthritis without baseline screening and clear failure of optimised conventional DMARDs.
• Do not biopsy a bone lesion before staging and without choosing a specialist team.
• Do not manage compartment syndrome with analgesia and observation.
• Do not forget developmental and metabolic causes of a limp in a child.

• musculoskeletal/adult-orthopaedic-injuries
• musculoskeletal/bone-metastases-and-pathological-fracture
• musculoskeletal/compartment-syndrome
• musculoskeletal/giant-cell-arteritis-and-polymyalgia-rheumatica
• musculoskeletal/gout-and-pseudogout
• musculoskeletal/joint-examination-and-approach-to-joint-pain
• musculoskeletal/low-back-pain-disc-herniation-and-spinal-stenosis
• musculoskeletal/osteoarthritis
• musculoskeletal/primary-bone-tumours-in-adults
• musculoskeletal/rheumatoid-arthritis
• musculoskeletal/soft-tissue-sarcoma
• musculoskeletal/spondyloarthritis-and-ankylosing-spondylitis
• musculoskeletal/systemic-lupus-erythematosus
• musculoskeletal/systemic-sclerosis
• musculoskeletal/vasculitis-anca-and-medium-vessel
• infectious-disease/septic-arthritis
• endocrinology/osteoporosis
• pediatrics/developmental-dysplasia-of-the-hip
• pediatrics/leg-calve-perthes-disease
• pediatrics/paediatric-orthopaedic-injuries
• pediatrics/scoliosis
• pediatrics/slipped-capital-femoral-epiphysis
• pediatrics/clubfoot-and-metatarsus-adductus
• emergency-medicine/fracture-principles-open-fractures-compartment-syndrome
• emergency-medicine/long-bone-fractures-fat-embolism-and-dislocations
• emergency-medicine/pelvic-and-hip-fractures