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Arthritis Self-Management Progress Tracker

Daily Monitoring Chart for Arthritis Symptoms and Treatment Response

Orthopedics

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _______________ Date Started: _______________

Daily Symptom Tracking

Pain Level (0-10 Scale)

Date Morning Afternoon Evening Activities Affecting Pain

Joint Stiffness

  • Duration of morning stiffness: ___ minutes
  • Affected joints (mark with X):
    • □ Fingers □ Wrists □ Elbows □ Shoulders
    • □ Hips □ Knees □ Ankles □ Toes

Medication Log

Medication Dosage Time Taken Side Effects

Physical Activity Record

  • Type of exercise: _______________
  • Duration: ___ minutes
  • Intensity (circle): Light / Moderate / Vigorous
  • Post-exercise pain level: ___

Environmental Factors

  • Weather conditions: _______________
  • Temperature: _______________
  • Impact on symptoms: □ Better □ Worse □ No change

Weekly Goals

  1. Pain management target: _______________
  2. Exercise goals: _______________
  3. Lifestyle modifications: _______________

Healthcare Provider Notes

Next appointment: _______________ Treatment adjustments: _______________

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