What to expect from your first rheumatology visit?

Visiting a new doctor, especially a specialist can be scary. It is helpful to conduct a little bit of research before you go, so you know what to expect, what’s going to happen at your visit and so you aren’t completely in the dark. 

Who is a Rheumatologist?

A rheumatologist is either an internist, a doctor who specializes in internal medicine, or a pediatrician, a doctor who treats children from infancy to young adulthood. A rheumatologist has special training in diseases that afflict the joints, muscles, and bones, including conditions that are widely known as autoimmune conditions and rheumatic disease. 

The various conditions a rheumatologist treats include:

• Long-term back pain

• Gout

• Lupus

• Osteoarthritis

• Rheumatoid arthritis

• Tendinitis

• Psoriatic arthritis

The doctor will create a treatment plan to manage these conditions in the best way for you. At your first rheumatologist consultation, the doctor will have a conversation with you and examine you. The first rheumatology appointment can be time-consuming, taking up to an hour or so, but it is imperative and well worth your time. 

Since the conditions a specialist rheumatologist deals with are chronic, you will be seeing the doctor often and for a long time to come, therefore, you should look for someone you connect well with after receiving a rheumatological diagnosis. 

How is your Rheumatology appointment structured?

Your appointment will have several steps to it:

1. Review of your medical history: 

The first thing the consultant rheumatologist needs to know is why you had to make an appointment in the first place. You should keep a record of your symptoms and bring them with you to your appointment. The rheumatologist will ask you questions about your pain, such as the location, where it hurts, when it hurts, what sort of pain is it, and when it started. They will also ask other questions such as:

• Symptoms besides pain, such as insomnia, or fatigue

• For how long the symptoms have persisted

• What makes you feel better?

• What makes you feel worse?

• Which activities cause pain? Such as walking, reaching, and sitting. 

• The medications you are on

• Any allergies you may have

• if anyone in the family has had some kind of autoimmune disease. You should be aware of the medical history of the family-like uncles and aunts.

2. Physical Examination: 

Once your rheumatologist consultation is underway, and the doctor has asked about your symptoms, he will conduct a physical examination. During this examination, he or she will press on each of your joints to gauge your pain reaction and assess how many and which of your muscles or joints are inflamed or tender. 

You should give honest answers to your doctor when he asks how the pressure makes you feel. You can share the magnitude of pain in words, such as mild or severe, or you will be asked to rate it on a scale of 1 to 10. 

3. X-Rays: 

The next step for the doctor will be to order an X-ray of the joints and areas that you have reported as painful. X-rays allow the doctor to see your joints from the inside. The images will show joint damage, as well as the degree of inflammation that has occurred. 

If you get a rheumatology diagnosis, it is helpful to have a baseline set of x-rays that can help the specialist rheumatologist in assessing the progression of the condition. 

4. Ultrasounds: 

Sometimes, X-rays aren’t sufficient enough for your consultant rheumatologist to analyze your joints fully. Therefore, the doctor may decide to conduct an ultrasound. You will be able to see the ultrasound on the screen, and the doctor will point out areas of concern, such as inflammation and how severe the condition is to you. 

In addition, he or she may compare the results of your ultrasound with a control medium, to confirm the diagnosis better. 

5. Blood tests: 

The doctor will also want to check your blood and other fluids. The doctor will use a syringe to take blood or joint fluid, which will be sent to the lab to look for signs of inflammation like:

• Rheumatoid factor: created when the healthy tissue is under attack

• Synovial fluid: tested to check for proteins, signs of infection, and consistency

• C-reactive protein: the levels of this go up when there is inflammation

• Anti-cyclic citrullinated peptides or anti-CCP antibodies: signals bone damage caused by rheumatoid arthritis

• Erythrocyte sedimentation rate or ESR/sed rate: used to measure the speed at which blood settles at the bottom of the test tube. If it settles faster, there is inflammation in the body. 

Using all this information, the rheumatologists decide what to do next, by setting treatment goals like getting the condition under control and improving quality of life.