Why does a rheumatologist see you?
A rheumatologist is a specialist physician who is board certified in treatment of arthritis and other diseases of the joints, muscles, and bones. The word rheumatism refers to conditions characterized by inflammation and pain, with some being classified as autoimmune diseases. There are over one hundred types of rheumatic diseases. Some of the more common ones are:
- Osteoarthritis
- Rheumatoid arthritis (RA)
- Lupus
- Psoriatic arthritis
- Ankylosing spondylitis
- Sjogren’s Syndrome
- Gout
- Scleroderma
- Infectious Arthritis
Why am I being referred to a rheumatologist?
When your primary physician refers you to a rheumatologist, it is typically to provide a specialized treatment plan for a rheumatic condition, or to do additional testing to determine if you need further treatment.
Typical reasons that prompt a referral might be pain that involves multiple joints and isn’t getting better with typical pain management treatments; a family history of a rheumatoid disease; or symptoms that suggest a systemic illness that is causing joint pain and mobility issues.
What happens at your first rheumatologist appointment?
You can expect the rheumatologist to do a thorough history and physical at your first appointment. A thorough medical history, including known family history is important to understand your risk factors. Many rheumatological diseases are hereditary.
The physical exam will typically include an assessment of your joints, swelling, range of motion, any skin rashes or psoriasis. The rheumatologist will also gather more information from lab tests and imaging tests, such as X-ray, CT, or MRI scans.
What questions will a rheumatologist ask?
The primary questions your rheumatologist will ask concern the history of your current pain or illness. You will be asked to provide specific descriptions of your pain, such as:
- Location(s)
- When it started
- What it feels like (sharp, dull, achy, throbbing)
- How severe the pain is (often rated on a scale of 0-10)
- Does the pain come and go, or is it constant?
- Is it worse in the morning?
- Does it affect your quality of life?
- What helps your pain? (Such as exercise, OTC meds, heat, cold)
- Do you have flare-ups, and how long do they last?
- Does anyone else in your family have the same problems?
You will need to provide as much detailed information as you can to help the rheumatologist arrive at a diagnosis and treatment plan.
What symptoms does a rheumatologist look for?
Symptoms of rheumatic illnesses, such as the ones listed in section one, can often come on slowly. However, for some specific problems, it is a faster progression. These symptoms can be debilitating over time and cause lasting damage to bones, muscles, and organs.
Symptoms your rheumatologist will look for are:
- Joint pain
- Swelling of a joint or joints (inflammation)
- Joint stiffness that is worse in the morning hours
- Chronic pain or tenderness at the joints.
- Warmth or redness in a joint area
- Limited movement in an affected joint or joints
- Fatigue
Symptoms of rheumatic diseases can happen at any age; however they most commonly begin in the 40s or 50s. Some of the first noticeable symptoms are fatigue; more than just tiredness, but an extreme lack of energy and motivation. Some illnesses also arrive with a slight fever. The body is trying to fight off inflammation and this will cause a feeling of general malaise and a low-grade fever. Weight loss can also accompany the onset of illness.
What blood tests does a rheumatologist do?
Rheumatologists may order lab tests to be completed, both to help diagnose you and to establish baseline levels to compare after treatment has occurred. These lab tests may be tests of the blood, urine, or joint fluid. Some may look for antibody markers for specific conditions, and others assess for genetic markers.
Some of the most common tests are:
- Anti-cyclic citrullinated peptides (anti-CCP) antibodies
- Anti-nuclear antibody (ANA)
- Complete blood count (CBC)
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR or sed rate)
- HLA-B27 genetic markers
- Rheumatoid factor
- Synovial fluid analysis
- Various vitamins and minerals such as calcium and vitamin D
Illnesses of the joints and muscles not only affect quality of life, but they can also create irreversible damage. There are many new medical treatments and medications available now that can increase quality of life. Visiting your rheumatologist is the first step towards managing symptoms and getting your old life back.
