Rheumatologists: What They Do, and What to Expect

If you think you may have rheumatoid arthritis and are about to see a rheumatologist for the first time, you're on the right path. Studies show that the earlier you’re treated for your rheumatoid arthritis, the more likely you are to feel better sooner and stay active longer.

What Is a Rheumatologist?

They’re an internist (a doctor who specializes in internal medicine for adults) or a pediatrician (a doctor who treats children from birth to young adulthood). They’ve had special training in diseases that affect your joints, muscles, and bones, including those known as autoimmune conditions, or rheumatic diseases. Conditions they treat include:

These doctors have the training to make a treatment plan just for you. Your first visit will be part conversation, part examination. Your appointment may take an hour or more, but it will be well worth the time.

Because RA is a long-term disease, you'll see this doctor often. They'll keep your treatment on track and work with you to manage your condition.

Where Do Rheumatologists Work?

You’ll find them mostly in outpatient clinics. They’re usually linked with a local hospital, so they can work with people admitted there for treatment of rheumatic diseases.

How Do I Find One?

Your primary care doctor can refer you to a rheumatologist. But if your insurance doesn’t require a referral, you can call them and make an appointment on your own.

What Questions Will My Rheumatologist Ask?

One of the first questions the doctor will ask is, "What brings you here?" This is your chance to tell them how RA is affecting your life.

Then, get ready to answer a lot of other questions, like:

  • What are your symptoms?
  • How often do you have symptoms? (All the time, daily, weekly, every now and then?)
  • What makes you feel better? (Exercise, rest, medicine?)
  • What makes you feel worse? (Lack of activity, not enough sleep, stress, eating a certain kind of food?)
  • What activities cause pain? (Walking, bending, reaching, sitting for too long?)
  • Where on your body is the pain?
  • How bad is the pain?
  • Which words best describe your pain? (Dull, sharp, stabbing, throbbing, burning, aching, cramping, radiating?)
  • How does the pain make you feel? (Tired, upset, sick?)
  • Does it stop you from doing things you enjoy? (Gardening, shopping, taking care of children, having sex?)
  • Are there symptoms other than joint, muscle, or bone pain that seem to be linked? (Rashes, itching, dry mouth or eyes, fevers, infections?)
  • Does anyone in your family have RA?

Some of the questions may not seem to be about rheumatoid arthritis, but your doctor has a good reason for asking them. Tell them if you want to know why or if you feel uncomfortable.

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What Questions Should I Ask?

You should also ask any questions you have about the visit and the recommended treatments. It's natural to wonder things like:

  • How advanced is my arthritis? Is there damage to my joints?
  • How long will it take for me to feel better?
  • What can I do to sleep through the night?
  • What are the potential side effects of RA medicines?
  • How can I prevent those side effects? When should I call you about them?
  • I don’t like to take medicine. What are my other options?
  • Will I have to take RA drugs for the rest of my life?
  • What should I do when the pain flares?
  • What types of exercise should I do?
  • Would physical therapy help me?
  • Are there any natural or complementary treatments I could try?
  • Are there any foods I should avoid?
  • Do I need to make any changes at work?
  • Do you recommend that I look for a clinical trial?
  • Should I worry about my children getting it?
  • Will I become disabled?
  • Does it affect other parts of my body?
  • Where can I find resources to help me learn more about living with the disease?
  • How can I find a support group?

The Physical Exam

It starts out much like any standard office visit. Your doctor will:

  • Check you from head to toe, including your eyes, mouth, and skin
  • Look for signs of inflammation, like swelling, warmth, redness, nodules (growths under the skin), and rashes
  • Take your pulse and listen to your heart, lungs, and bowels
  • Press on your joints to see if they're sore

Then, they’ll ask you to bend, flex, and stretch your joints and muscles. They’ll compare the joints on one side of your body with those on the other, because RA often affects both sides. This part of the exam may cause some pain, but it’s important for the doctor to see you move. Speak up if it hurts too much.

What Are the Tests for Rheumatoid Arthritis?

The doctor will want to check your blood and other fluids. They’ll also probably take images of your joints.

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Lab tests

The doctor may use a needle to take blood or joint fluid while you’re in the office. Or they might send you to a lab for these tests. Rheumatologists look for signs of inflammation like:

  • Anti-cyclic citrullinated peptides (anti-CCP) antibodies. They signal bone damage caused by RA.
  • C-reactive protein (CRP). Levels go up when you have inflammation.
  • Erythrocyte sedimentation rate (ESR or sed rate). It measures the speed at which your blood settles to the bottom of a test tube. Faster settling is a sign of inflammation.
  • Rheumatoid factor. Your body churns out these proteins when it attacks healthy tissue.
  • Synovial fluid. Your doctor will test it for proteins, signs of infection, and a lack of thickness.

Imaging tests

Your doctor may order X-rays; an MRI scan, which uses powerful magnets and radio waves to make a more detailed picture; or a CT scan, which takes X-rays from several angles and puts them together to get more information.

You might not get a definite RA diagnosis on your first visit. In some cases, it can take a few appointments for your rheumatologist to rule out other causes of your joint pain.

What Are the Next Steps?

Your rheumatologist will use all of this information to decide what to do next.

They may work with you to set treatment goals that show the disease is getting under control, like fewer signs of inflammation in your blood, as well as goals for quality of life, like enjoying family activities.

Medications. Your rheumatologist will probably prescribe methotrexate, which is a disease-modifying antirheumatic drug (DMARD). These medicines put the brakes on your immune system so it stops attacking your joints. The result is less inflammation and less pain. Your doctor may also tell you to take over-the-counter medicines for pain or prescribe low-dose corticosteroids to ease swelling.

If your RA is further along, you may need stronger medications called biologic response modifiers. Over time, you and your rheumatologist will find the right mix for you.

Physical therapy or occupational therapy. Your doctor may suggest that you meet with one or both of these health professionals. Physical therapists can teach you exercises to help you move your joints and make them stronger. Occupational therapists can show you how to ease the strain on your joints during daily activities.

Lifestyle changes. Exercise and weight control may be parts of your treatment plan. You need to move your joints to keep them from getting stiff and to strengthen the muscles around them. If you’re overweight, shedding extra pounds can take stress off joints and lessen pain.

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What Can I Do to Help?

Rheumatologists are like detectives looking for clues to relieve your pain and treat your condition. To give your new doctor a head start:

Make a timeline. Go back as far as you can remember. Describe your symptoms and how they've changed over time.

Do some family research. What kinds of problems run in your family? Find out what you can about the health of your grandparents, parents, and any brothers and sisters.

List your meds. Your rheumatologist will need to know about every medication you’re taking:

  • All your prescriptions for RA and other health problems
  • Over-the-counter medicines, rub-on creams, and other pain relievers
  • Vitamins, herbs, and supplements

You can write up a list or toss all the bottles in a bag and take them with you.

Ask your other doctors for copies of your records and any test results or X-rays, and take them with you, too.

By the end of this first visit, your new rheumatologist will know a lot about you and your RA. And you’ll have a new valuable partner on your health care team.

WebMD Medical Reference Reviewed by David Zelman, MD on June 02, 2020

Sources

SOURCES:

American Academy of Pediatrics: “Definition of a Pediatrician.”

American College of Physicians: “About Internal Medicine.”

American College of Rheumatology: "Rheumatoid Arthritis," "Simple Tasks," “What Is a Rheumatologist?” “Importance of Following Your Treatment Plan.”

American Physical Therapy Association: "Who Are Physical Therapists?"

Arthritis Foundation: "Benefits of Weight Loss," "Prepare for Your Doctor Visit,” "What is Rheumatoid Arthritis?”

Cleveland Clinic: "First Rheumatology Appointment?" "Rheumatoid Arthritis."

Hospital for Special Surgery: "The Doctor-Patient Relationship and Rheumatology Decision-Making: Are You Thinkin' What I'm Thinkin'?" "Exercising With Rheumatoid Arthritis,” “Rheumatoid Arthritis,” "Ask the Expert: When Should You See a Rheumatologist?”

Mayo Clinic: “C-reactive protein test,” "Reactive Arthritis," "Rheumatoid Arthritis," “Rheumatoid factor,” Sed rate (erythrocyte sedimentation rate).”

Pala, O. Cavaliere, F. Clinical Care in the Rheumatic Diseases.

University of Washington Orthopaedics and Sports Medicine: "Managing Arthritis Pain."

Wheeless’ Textbook of Orthopaedics: “Laboratory Aspects of RA.”

World Federation of Occupational Therapists: "Definition of Occupational Therapy."

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