Rheumatologists -- What They Do and What to Expect

If you’re about to see a rheumatologist for the first time, you're on the right path. Studies show 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 special 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.

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 will refer you to a rheumatologist. Not all require you to have a referral, which means you can call them up and make an appointment on your own. Check your insurance first; it may require you to get a referral.

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 him how RA is affecting your life.

Then, get ready to answer a lot of 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?)

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

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What Questions Should I Ask?

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

  • How long will it take for me to start to feel better?
  • What can I do to sleep through the night?
  • 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?
  • Where can I find resources to help me learn more about living with the disease?
  • How can I find a support group?

Rheumatologists have the special 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.

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 she'll ask you to bend, flex, and stretch your joints and muscles. She’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. She’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 she 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: Levels go up when inflammation is present.

Erythrocyte sedimentation rate (ESR): Your doctor may call it 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

She might use X-rays, MRIs, or an ultrasound to get pictures of the damage to your joints.

What Are the Next Steps?

Using what you've shared about your RA, your medical history, the exam, and test results, your rheumatologist will have enough information to decide on the next steps.

Medications: Your doctor will probably give you a drug called methotrexate. She may tell you to take over-the-counter medicines like aspirin, , or for pain. She could also prescribe low-dose corticosteroids to ease the 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 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 will be part 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.

What Can You 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:

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Create 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
  • Include over-the-counter medicines like , 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 will have a new, valuable partner on your health care team.

WebMD Medical Reference Reviewed by David Zelman, MD on April 09, 2018

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?”

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

Arthritis Foundation: "Benefits of Weight Loss," "Prepare for Your Doctor Visit:"

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

Hospital for Special Surgery: "The Doctor-Patient Relationship and Rheumatology Decision-Making: Are You Thinkin' What I'm Thinkin'?" and "Exercising With Rheumatoid Arthritis."

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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