Reasoning GP · Algorithm · 1-page summary
Generalised body aches in adults
For: adults with new widespread aches, myalgia, stiffness or polyarthralgia. Not for: children, or pain in one joint or region (use that region's algorithm). Known PMR, GCA or RA: use their protocols.
Core rule: separate pain, stiffness, joint swelling and true weakness. In anyone aged 50+, ask about GCA symptoms first — and never delay steroids for blood results when GCA is suspected.
0Stop — call 999 now
- Sudden visual loss (GCA complication) → 999. Do not delay corticosteroids awaiting results.
- Acute severe or respiratory weakness, sepsis, acute confusional state or haemodynamic compromise → 999
1Triage by pattern — separate first
| Finding | Think → next step |
|---|---|
| Objective proximal weakness | Myopathy → CK; progressive → Same-day |
| Objective synovitis | Inflammatory arthritis → Urgent rheumatology |
| 50+, proximal pain + stiffness | Raised markers → consider PMR after mimics and GCA questions |
| Systemic features | Bone pain, anaemia, hypercalcaemia, renal impairment → investigate malignancy, myeloma, infection |
| Pain only | No synovitis or weakness → consider chronic primary pain / fibromyalgia after assessment |
2Screen — one row is enough
- GCA, aged 50+: new headache, scalp tenderness, jaw/tongue claudication, visual symptoms, abnormal temporal artery → bloods; steroids without waiting; Same-day GCA pathway. Visual, diplopia, neurology → Same-day ophthalmology / acute
- Progressive true weakness, dysphagia, dysphonia, dark urine or rapidly rising CK → Same-day acute medicine + specialist discussion
- Hot swollen joint or sepsis → Same-day hospital (aspiration)
- Haematuria + arthralgia: urine ACR/PCR, renal function; renal, lung or neuro involvement → Same-day
- Bone pain, thirst, polyuria, confusion: urgent FBC, calcium, renal, ESR/PV, electrophoresis, free light chains; severe hypercalcaemia or AKI → Same-day admission. Results suggest myeloma → Suspected cancer pathway (NG12)
- Weight loss + night sweats → bloods, NG12 route for the likely site. Rash + arthralgia → Urgent rheumatology
3Assess
☐ Fever, weight, nodes, rash (butterfly, heliotrope, Gottron's) ☐ Joints for synovitis; scalp, umbilicus, nails for psoriasis ☐ Rise from chair, arms overhead: true vs pain-limited weakness ☐ Temporal arteries if 50+ ☐ Medicines: statins, steroids, fluoroquinolones, colchicine ☐ Mood, sleep
Persistent or unexplained: FBC, ESR/CRP, U&E, LFTs ± TFTs, calcium, glucose. Not routinely: CK, vitamin D, ANA, RF/anti-CCP, HLA-B27.
4Classify — only if the screen is negative
- PMR — 50+, bilateral shoulder/hip pain and stiffness, morning stiffness >45 min, usually raised CRP/ESR → exclude mimics, ask about GCA.
- Inflammatory arthritis — synovitis, small joints, psoriasis → urgent rheumatology; do not wait for RF/anti-CCP.
- Viral / post-viral — acute, with fever; self-limiting. Post-exertional malaise → ME/CFS (NG206), no graded exercise therapy.
- Drug or endocrine — statin timing (CK, TFTs), steroids, alcohol; hypothyroidism, Cushing's, Addison's.
- Fibromyalgia — widespread >3 months, fatigue, unrefreshing sleep, cognitive fog; clinical diagnosis, no blood test.
- Uncertain — say so; genuine uncertainty → rheumatology. Fibromyalgia and arthritis can co-exist.
5Treat today — doses: NICE/SPC, BNF, local formulary
- PMR, mimics excluded: prednisolone 15 mg trial. Poor response → reconsider the diagnosis. Bone protection; ask about GCA every review.
- Fibromyalgia: positive explanation; offer supervised group exercise; consider CBT or ACT, and amitriptyline or duloxetine (off-label) after shared decision. Do not start opioids, NSAIDs, paracetamol or gabapentinoids.
- Statin symptoms: CK, TFTs, interactions. Marked weakness, dark urine, AKI or high CK → Same-day. Intolerance → lower dose, other statin or ezetimibe.
- Vitamin D: colecalciferol only for confirmed deficiency.
6Refer routinely
- PMR atypical, normal markers, poor response, relapse or steroid dependence → Urgent rheumatology
- Psoriatic arthritis, SpA, genuine uncertainty → rheumatology. Typical fibromyalgia does not need it.
- Cushing's or Addison's features → endocrinology. CBT/ACT → NHS Talking Therapies.
7Never reassure by
- A good steroid response — it does not confirm PMR.
- Normal ESR/CRP — prompts reconsideration, not exclusion of PMR.
- Negative RF/anti-CCP when synovitis is convincing.
- A normal CK or a normal Hb (myopathy, myeloma).
- A low vitamin D or positive ANA "explaining" the aches.
- A functional label with weight loss, night sweats or bone pain.
8Safety-net — say it, then document it
999 “Call 999 for sudden loss of sight, sudden severe weakness or trouble breathing, new confusion, or if you collapse or feel very unwell with a fever.” Same day: “New headache, scalp tenderness, jaw pain on chewing or any change in vision; weakness getting worse, trouble swallowing, dark urine, a hot swollen joint, or a new rash with joint pains — contact us today.”
Review results at 4–6 weeks. PMR: warn about GCA symptoms at every review.
✓Safe to leave primary care only if — all five, documented
No block 0–2 row applies
GCA symptoms asked if 50+
True weakness and synovitis looked for
Targeted tests only; review date set
Safety-net given, incl. GCA symptoms
Summary of the full Reasoning GP generalised body aches algorithm, which holds the history, examination, investigations and evidence. Sources: BSR GCA guideline 2020, BSR/BHPR PMR guideline, BSR inflammatory myopathy 2022, NICE NG193, NG100, NG206, NG12 (updated April 2026); NOS vitamin D; local Formulary. Clinical reference — check doses: NICE/SPC, BNF.