Most rheumatological diagnoses are made through effective history taking and physical examination rather than investigation. Systemic symptoms, such as weight loss, anorexia, and fever, point to systemic diseases such as rheumatoid arthritis, other polyarthritides, systemic lupus erythematosus, polymyalgia, and vasculitides. Swelling of joints is a symptom commonly reported by patients with no objective evidence of this on examination. Inflammatory arthropathies should not be diagnosed unless the physician is able to identify objective swelling, if necessary by arranging a prompt review during an active episode. Diagnostic criteria for the systemic rheumatic diseases are useful in directing the history taking to verify a suspected diagnosis. Investigations are best used to confirm a strongly suspected diagnosis, already made on the basis of history and examination, not as a screening tool for rheumatic disease.