What Should I Expect When I See A Rheumatologist
Appointments often include discussing your symptoms, personal- and family medical history and lifestyle. Rheumatologists also perform a thorough physical exam.
Your evaluation may include one or more diagnostic tests, including:
- Biopsy to test tissue for signs of autoimmune disease.
- Blood tests to check liver or kidney function.
Your care may also include periodic testing and monitoring. Many inflammatory conditions may progress over time, requiring your rheumatologist to reassess your treatment plan. Rheumatologists try to stay ahead of these changes by seeing you regularly. These frequent touchpoints make it easier to adjust therapies before you experience discomfort.
A note from Cleveland Clinic
Rheumatologists treat a range of conditions that can be lifelong and complex. Many are difficult to diagnose, and some lead to permanent joint damage. Thats why its important to see a rheumatologist. They conduct thorough exams to pinpoint the precise cause of your symptoms. Your rheumatologist will develop a personalized care plan. They may also recommend monitoring to stay on top of changes that may signal the need for additional treatments.
Last reviewed by a Cleveland Clinic medical professional on 01/30/2022.
References
Ask A Doctor: Rheumatoid Arthritis
Hand surgeon Mark Joseph Yuhas, MD answers your questions about rheumatoid arthritis.
What is arthritis? Can it affect the hand and wrist just the same as other joints such as the hip and knee?
Arthritis is a term that is used to describe pain and stiffness in a joint. A joint is a location in the body where two bones articulate, or move. Typically these joints have cartilage, a type of material in the body that is smooth and helps the joint to move without pain or restriction.
Arthritis involves a process where the cartilage is no longer smooth and begins to break down. This can result in pain, swelling, and loss of motion in many joints in the body including the fingers, hand, and wrist.
Are there different types of arthritis?
Yes, there are multiple forms of arthritis that can affect the joints. Generally, we describe arthritis as degenerative or inflammatory. There are other forms or causes of arthritis, such as gout, infection, or post-traumatic.
Rheumatoid arthritis is a type of inflammatory arthritis. Other types of inflammatory arthritis include psoriatic arthritis, lupus, and ankylosing spondylitis.
How is rheumatoid arthritis different than other types of arthritis such as osteoarthritis? Do they have similarities?
Rheumatoid arthritis is a type of autoimmune arthritis. It causes protective mechanisms in our body to instead attack certain structures, including the joints.
What is the cause of rheumatoid arthritis?
What Did You Look For In Your Rheumatologist
I looked for a gentle, confident, wise, reassuring bedside manner, says Seth D. Ginsberg, cofounder and president of the Global Healthy Living Foundation, an advocacy group for people living with chronic illnesses.
I was interested in someone I could relate to, have a conversation with, and explain my situation to in broader terms than just my aching joints. My wife came with me during the first visit and joined us in the exam room. Her opinion mattered, too, says Ginsberg.
Udell agrees that one of the first things to consider is the doctors personality and how well it meshes with yours especially if your disease is a serious, chronic one such as rheumatoid arthritis.Thats because your relationship with the rheumatologist could be a very long one, which is one reason I went into this specialty, Udell says.
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And, he notes, the doctor-patient relationship should be nurtured as time goes on. If thereâs an issue that the patient and physician donât see eye-to-eye on, for example, they need to discuss it.
Or you might want to be more aggressive about treatment options while your doctor wants to be less aggressive this is also something you two must discuss, he says.
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Delays In Getting Diagnosed With Psoriatic Arthritis Are All Too Common Knowing What To Expect May Help Speed Up The Process
If your shoes are feeling tighter than usual or youre having difficulty or pain opening jars, a type of autoimmune disorder called psoriatic arthritis could be to blame. PsA is an inflammatory arthritis linked to psoriasis . It is characterized by pain, stiffness, and swelling in the joints although these general arthritis symptoms can take on specific characteristics when they are caused by psoriatic arthritis
As with many conditions, early diagnosis and prompt treatment are important. If you put off seeing the doctor, there are two major concerns with a delayed psoriatic arthritis diagnosis, says Bharat Kumar, MD, Associate Rheumatology Fellowship Program Director at University of Iowa Health Care and member of the American College of Rheumatology.
First, he explains, disease activity may worsen and cause lasting joint damage. Second, PsA is linked to a higher rate of heart disease, so the sooner youre diagnosed the quicker you can address cardiovascular factors like high cholesterol and hypertension. Rheumatologists are eager to see anyone with psoriasis who is also experiencing joint pain, Dr. Kumar says.
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How Is Psoriatic Arthritis Diagnosed
A single medical test is not available to diagnose psoriatic arthritis. To find out whether you have psoriatic arthritis, your doctor will do the following:
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Look at your medical records.
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Ask you specific questions. This usually includes questions such as whether any of your blood relatives have psoriasis or psoriatic arthritis.
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Examine your joints. This examination includes looking at your body to see whether you have swollen joints. Your doctor will gently press on the skin around certain joints to find out whether the area is tender.
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Send you for medical testing. This may include x-rays and a blood test.
Before giving you a diagnosis, your doctor considers your test results and everything he or she learned while meeting with you. In case youre wondering, the result from your blood test cannot tell whether you have psoriatic arthritis. It tells your doctor whether you have inflammation throughout your body. People who have psoriatic arthritis have body-wide inflammation. Many other diseases also cause body-wide inflammation. Inflammation is a piece of the puzzle.
Because psoriatic arthritis can look like other types of arthritis, patients often see a dermatologist or rheumatologist for a diagnosis. A rheumatologist is a medical doctor who specializes in diagnosing and treating arthritis and other diseases of the joints, muscles, and bones. Rheumatologists and dermatologists generally have the most experience diagnosing and treating psoriatic arthritis.
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Risk Factors & Prevention
Risk factors for arthritis include:
- Family history. Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. Your genes can make you more susceptible to environmental factors that may trigger arthritis.
- Age. The risk of many types of arthritis including osteoarthritis, rheumatoid arthritis and gout increases with age.
- Gender. Women are more likely than are men to develop rheumatoid arthritis, while most of the people who have gout are men.
- Previous joint injury. People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
- Obesity. Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. Obese people have a higher risk of developing arthritis.
- Genetics. Specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis and systemic lupus erythematosus , and ankylosing spondylitis.
Reduce the onset of arthritis by:
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It is in your best interest to get your arthritis checked out to lessen the pain and the likelihood of needing surgery. Intervention at an early stage can prevent it from getting worse. If you observe symptoms of arthritis, see an orthopedic doctor near you.
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Coping With Low Mood And Sleeping Difficulties
Arthritis can take a mental toll on a person, leading to anxiety and depression related to the condition. Depression and anxiety can lead to sleep issues.
A person may benefit from psychotherapy, such as cognitive behavioral therapy or traditional talk therapy.
RA and PsA can both cause fatigue, which can make a person feel extremely tired even after rest.
A person the following steps help improve sleep quality:
- making the bedroom dark, quiet, and cool
- removing electronic devices from the bedroom, such as TVs and computers
- going to bed at the same time each night
- avoiding alcohol, caffeine, and large meals before bed
- participating in regular exercise
What Type Of Doctors Treat Arthritis
Part of your treatment plan may involve working with different healthcare specialists. Some common healthcare professionals and their role in your treatment are described below. Most doctors make referrals to one of a group of health professionals with whom they work. But you too can ask your doctor to request medical services you think might help you.
Your family doctor may be an excellent source of medical care for your arthritis. Besides having your medication records, your family doctor already has your medical history, is familiar with your general physical health and knows of any past illnesses or injuries. All these facts will give your family doctor a head start in prescribing a treatment plan most suited to your needs.
If your arthritis affects many joints or other parts of the body or seems resistant to treatment, you may benefit from seeing a rheumatologist. This is a doctor with special training and experience in the field of arthritis. Your family doctor, the local chapter of the Arthritis Foundation or the county medical society can refer you to a rheumatologist. You can also search for a rheumatologist on the American College of Rheumatology website.
Pharmacists fill your prescriptions for medicines and can explain the drugs actions and side effects. Pharmacists can tell you how different medicines work together, when and how to take your medications and can answer questions about over-the-counter medicines.
Conditions
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Surgery For Spinal Arthritis
Surgery may be recommended for spinal arthritis if other treatments donât sufficiently relieve pain. The goals of the surgery may include:
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Stabilizing the spine by fusing several segments together in a procedure called spinal fusion
These surgeries can be performed as open procedures or with a minimally invasive approach. There are pros and cons to each method. The surgeon will review and discuss the options before the operation.
How Is Osteoarthritis Of The Spine Diagnosed
The best way to confirm a diagnosis of osteoarthritis is by X-ray. The doctor will take a medical history and perform a physical exam to see if the person has pain, tenderness, loss of motion involving the neck or lower back, or if symptoms are suggestive, signs of nerve involvement such as weakness, reflex changes, or loss of sensation.
The doctor may order certain tests to aid in the diagnosis of osteoarthritis of the spine. These tests include:
- X-rays to look for bone damage, bone spurs, and loss of cartilage or disc however, X-rays are not able to show early damage to cartilage.
- Blood tests to exclude other diseases
- Magnetic resonance imaging to show possible damage to discs or narrowing of areas where spinal nerves exit
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Do Dermatologists And Rheumatologists Ever Work Together
- Combined rheumatology-dermatology clinics are a newer frontier in the treatment of psoriatic arthritis, with just over 20 clinics in the United States
- Depending on the clinic, some rheumatologists and dermatologists may see a patient at the same time in the same room. Sometimes, separate back-to-back visits are required
- Studies show this combined care approach could achieve better outcomes for both skin and musculoskeletal symptoms
- A survey from the Psoriasis and Psoriatic Arthritis Clinic Multicenter Advancement Network found over 80% of doctors thought a combined clinic accelerated an accurate diagnosis
- Challenges are largely related to scheduling and billing
What Is Autoimmune Disease
An autoimmune disease involves your immune system attacking healthy tissues, cells, or substances in your body. The immune system mistakes the target for something dangerous, like a virus or bacterium, and tries to destroy it. This can lead to pain, inflammation, and a host of other symptoms that vary depending on whatâs being damaged.
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Rheumatic Diseases And The Spine
Rheumatic diseases that affect the spine can be very difficult to live with. These include:
- Rheumatoid arthritis: Often starts in smaller joints of the hands and feet and later moves to the neck and/or back. May also strike organs and have systemic symptoms.
- Ankylosing spondylitis: Primarily a disease of the spine, may also impact the shoulders, hips, knees, and ankles. Systemic symptoms including fever and fatigue are possible.
- Axial spondylitis: Primarily affects the spine, chest, and pelvis. May also cause problems in the eyes, bowel, skin, and connective tissues.
- Psoriatic arthritis: Pain in the lower back is common, especially in severe cases. Can affect other joints and causes psoriasis
- Reactive arthritis: A reaction to infection. Can involve the spine but is more common in the joints of the limbs, hands, and feet.
- Enteropathic arthritis: Mainly affects the spine but can include other joints. Associated with inflammatory bowel disease.
Can You Stop Gout
It should be fairly evident why youd need to get rid of gout, but could it be really achievable?
Sure is definitely, but theres not a one-size matches all solution.
Within the next section, well be exceeding whats worked greatest for us!
You wont want to miss out on this free video clip.
NOTICE: Id highly recommend going to your doctor or seeing a specialist about this situation, since we arent experts. See our medical disclaimer for more details.
We dont know what will work for you, but we know whats worked for us and others
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What Is The Difference Between A Rheumatologist Vs An Orthopaedist
Orthopaedists and rheumatologists specialize in conditions affecting the joints, bones, muscles, ligaments and tendons. They treat many of the same conditions, including joint pain and tendinitis. But there are a few differences between these medical specialties.
Rheumatologists consider every organ system when looking for the cause of your symptoms. An orthopaedist focuses on injuries, congenital disease and wear and tear . Also, orthopaedists perform surgery, but rheumatologists do not. While both rheumatologists and orthopaedists help diagnose and treat musculoskeletal conditions, rheumatologists have specialized training in musculoskeletal conditions of an inflammatory and autoimmune etiology.
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Are There Other Ways To Diagnose Arthritis
Examination of your joints by your doctor is the first, and one of the most important, ways of diagnosing arthritis. Your doctor will use blood tests to help confirm what they find on examination and from listening to your symptoms. Your doctor may also use a variety of other tests to help diagnose arthritis, including testing other body fluids and x-rays and scans . However it is possible to make a diagnosis of arthritis without any blood tests or imaging.
What Are The Symptoms Of Inflammatory Arthritis
The most common symptoms of inflammatory arthritis are:
- Joint pain and stiffness after periods of rest or inactivity, particularly in the morning
- Swelling, redness and/or a feeling of warmth in the affected joints
- Inflammation of other areas in the body, such as the skin or internal organs like the lungs and heart
People with inflammatory arthritis generally experience alternating periods of flares of highly intense symptoms with periods of inactivity.
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When To Contact A Doctor
A person should speak with a doctor if they suspect they may be developing arthritis in the arms or other areas of their body.
People with psoriasis have a higher chance of developing PsA and should contact a doctor if they notice any joint pain.
A person should prepare to share information such as:
- the presence of a rash
- whether or not they feel fatigued or have other symptoms seemingly unrelated to joint pain
- family medical history
- the severity of pain and stiffness
- when the pain or stiffness appears to worsen
- work history, such as manual labor that may have contributed to arthritis development
- the presence of other health conditions that may affect treatment
When consulting a doctor, a person may find preparation with questions and information can help. Some potential questions include:
- Will they need to run any tests?
- What therapies do they recommend?
- Are there any medications to avoid?
Diagnosis will vary based on what type of arthritis a doctor or medical professional suspects. Diagnosis will likely take the following steps:
- reviewing personal and family medical history
- performing a physical examination of the affected joints, such as checking for pain levels and range of motion
- ordering X-rays or other imaging technology to examine the joints
Once diagnosed, a doctor or other medical professional can develop a treatment plan to help manage pain, reduce stiffness, and improve range of motion.