Rheumatology: What Should I Expect When I See a Rheumatologist? - RheumatoidArthritis.org (2023)

Jennifer Freeman, MD

Doctor of Medicine (M.D.) in 2008 from UT Health San Antonio, Surgeon at TRACC Dallas

Mar 25, 2019 7 min read

A rheumatologist is a vital part of a rheumatoid arthritis (RA) patient’s healthcare team as he or she is the physician best able to diagnose the initial condition. The rheumatologist also recommends and prescribes the medical treatments needed to slow or possibly even stop the disease from progressing, helps the patient manage symptoms (such as joint pain, stiffness, fatigue, and fever), and monitors the patient on an ongoing basis.

(Video) When Should I see a Rheumatologist?

What is a Rheumatologist?

A rheumatologist is a physician or pediatrician who is trained in the area of rheumatology. This enables him or her to better diagnose, treat, and care for patients suffering from a variety of rheumatic diseases.

Rheumatologists have experience in treating many different forms of arthritis—such as RA, osteoarthritis, and psoriatic arthritis—with a specialty focused on musculoskeletal diseases and systemic autoimmune conditions that affect the joints, bones, and muscles.

RA is a complex connective tissue disease, making it difficult to diagnose in its early stages. Additionally, it can easily be confused with other conditions which have similar symptoms, such as lupus and Lyme disease. However, because of their advanced knowledge in this area, rheumatologists are often able to detect early signs of RA and other forms of arthritis that other doctors may not be able to initially identify.

Obtaining a RA diagnosis may require several visits on your part, but once the rheumatologist identifies and analyzes your symptoms, he or she can better determine the exact diagnosis and treatment options most suitable for you, the patient.

What Qualifications do Rheumatologists Have?

As physicians specializing in rheumatology (which Merriam-Webster defines as “a medical science dealing with rheumatic diseases”), rheumatologists are medical professionals who have first obtained a bachelor’s degree, then completed medical school, and, after that, gone on to perform their residency, training in internal medicine or, if at a child hospital, in pediatrics.

Once their residency is completed, student rheumatologists must then undergo further specialized training through a rheumatology fellowship. This is usually an additional two to three year training period and is meant to provide a strong rheumatology foundation for the soon-to-be attending physician.

(Video) How is Rheumatoid Arthritis Diagnosed? | Johns Hopkins Rheumatology

After completion of their education and fellowship, the student must then pass a certification exam (which has to be retaken every ten years) to officially become a board certified rheumatologist. Once certified, the new rheumatology attending may begin offering treatment on their own.

They may do this by opening an individual rheumatology practice, by joining other established rheumatology practitioners, or by working for a hospital which has a rheumatology division, such as Brigham and Women’s Hospital in Massachusetts or Detroit Medical Center’s Division of Pediatric Rheumatology, located in Michigan.

Rheumatologists must also undergo annual continuing medical education courses and ongoing training to keep their skills and knowledge of rheumatologic diseases current and up to date. One of the main providers of these types of trainings and educational classes is the American College of Rheumatology.

According to Medscape, salary for practicing rheumatologists averages around $234,000 annually. PayScale salary information places this rheumatology specialty’s median slightly lower, closer to $205,000. According to these numbers, the rheumatologist salary is quite a bit lower than some specialties, like those practicing in cardiology or obstetrics and gynecology, but a little higher than others, such as for the doctors who specialize in treating allergies or pediatrics.

What do Rheumatologists Help With?

Because they studied in rheumatology specifically, rheumatologists are the physicians best able to diagnose a variety of rheumatic conditions (such as RA and osteoarthritis) by examining symptoms, performing medical tests, and asking specific questions of their patients.

As part of this process, the rheumatologist must also rule out other conditions which have the same type of joint pain or fatigue as RA. Some that are similar, yet must be treated differently, are lupus, Lyme disease, and relapse polychondritis. Once a diagnosis of RA is confirmed, the rheumatologist recommends ongoing medical treatments and monitors the patient regularly.

For patients with RA, rheumatologists assist with the treatment of its many symptoms, including joint pain, swelling and inflammation, stiffness, and deformities. Ultimately, a rheumatologist’s role in treating RA is to prevent joint damage or limit it as much as possible through aggressive, targeted treatments. They are also there to help improve the quality of life of their patients.

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Due to the complex and chronic nature of RA, rheumatologists must also look for any potential signs of complications that may arise because of the autoimmune condition. This includes monitoring for secondary health conditions which tend to be more common with RA patients, such as Sjogren’s syndrome and psoriatic arthritis.

Rheumatologists may also choose to participate in ongoing studies and conduct clinical trials in rheumatology in order to contribute to the advancement of scientific discovery. Their focus may be on finding new and better treatments for RA or other rheumatic conditions, if not a cure. They also help to refine diagnostic criteria as we continue to learn more about and better understand the various musculoskeletal and autoimmune conditions like RA.

When to See a Rheumatologist

In most cases, patients see a rheumatologist for treatment upon referral from their physician. In other words, physicians who are general practitioners generally refer their patients to rheumatologists when they suspect symptoms consistent with rheumatic diseases (such as chronic pain in the joints and fatigue) and want or need to confirm this diagnosis which is outside their normal realm or scope of expertise.

For example, if a patient complains of ongoing and persistent muscle and joint pain that does not go away after just a few days, the physician may want to investigate as to whether or not there is an underlying rheumatic condition or some other issue going on, such as lupus or osteoarthritis. It is extremely important for patients to see a rheumatologist and be diagnosed as soon as possible since RA can be treated most effectively if treatment begins early on in the disease’s course.

Patients also typically see a rheumatologist for support in providing the most appropriate and effective medications for their own unique condition. Of these, anti-inflammatory drugs are one of the most widely used non-surgical treatment options for relieving the pain associated with rheumatic diseases like RA.

You’ll likely see your rheumatologist at a specialized outpatient facility, such as an office which houses other internal medicine providers, or possibly directly within the hospital in their division of rheumatology. If the patient is a minor, as in the case of JRA, the pediatric rheumatologist may be seen in a children’s hospital or pediatric office setting.

Visiting The Rheumatologist

When visiting the rheumatologist, initially you will work with him or her to determine the diagnosis and/or severity of your rheumatology based condition. To do this, the rheumatologist will likely perform a full physical examination, ask many questions about the pain you have in your joints and other symptoms you may be experiencing, and learn more about your family and personal medical background.

(Video) Preparing for your rheumatology appointment

In preparing for your first visit to the rheumatologist, there are some items which are helpful to collect and bring with you. They include:

  • A list of the symptoms you’re experiencing (such as pain or stiffness in your joints) which cause you and/or your primary care physician to suspect some type of rheumatology
  • Past blood work results
  • Past imaging test results
  • A full list of current medications including any vitamins and supplements you take as well as any over the counter medications, like NSAIDs and analgesics
  • Information about medical allergies
  • Family medical history, including any known cases of rheumatic diseases (RA, rheumatic fever, or osteoarthritis, for instance) or other autoimmune diseases (any type of lupus, Lyme disease, ankylosing spondylitis) as some connective tissue diseases are hereditary

After the initial examination is complete, the rheumatologist may order additional testing and exams to further investigate your unique condition. Depending on what the rheumatologist finds, these further tests may include:

  • Blood tests
  • X-Rays
  • Ultrasounds
  • MRIs

The results of these tests will help the rheumatologist make a final diagnosis and determine whether or not you have RA, some other type of rheumatic disease, another autoimmune disease (such as psoriatic arthritis, systemic lupus erythematosus, or Lyme disease), or if there is another possible reason for the pain-based symptoms in your joints.

If you are diagnosed with RA, you will be placed on a treatment plan that addresses your unique case of RA. The treatment is based largely on how far the disease has progressed at the time of diagnosis. Again, early detection with RA is critical as the sooner it is found, the easier it is to treat.

Working With Your Rheumatologist

After your rheumatology diagnosis and the creation of your initial treatment plan, you will need to see your rheumatologist regularly as part of your overall treatment strategy. Because of the nature of rheumatology-based conditions, rheumatologists are responsible for assessing their patients on an ongoing basis to monitor the disease’s progress as well as to ensure that patients are responding well to their prescribedmedications.

As part of working with a rheumatologist, you will be provided with a personalized treatment plan that addresses your unique case of RA. This treatment plan can vary from person to person and depends greatly on your individual age, gender, family background, and personal medical history, as well as the amount of musculoskeletal pain and other symptoms that you’re experiencing.

Rheumatologists provide ongoing support to patients and make recommendations as to which drug types to try (or switch to if the current course of treatment is not working), therapies to pursue, and other specialists to see for even more support in managing daily symptoms and staying healthy. If your health condition goes beyond RA to include the addition of other diseases, this factor must be taken into consideration as well.

(Video) Johns Hopkins Rheumatology Clinic : What to Expect During Your Visit

Ask Your Rheumatologist Questions

RA is a serious and chronic disease that currently has no known cure. Therefore, it’s important to understand your condition as best as possible so you can take charge of your personal health.

Don’t be afraid to ask your rheumatologist lots of questions about your symptoms, your disease’s progress, and the medications typically used to treat RA (like NSAIDs, corticosteroids, and disease-modifying antirheumatic drugs). It’s important to address any concerns you may have about your overall condition and/or the medications you are taking.

The more you know about your RA, the better decisions you can make about which treatment is right for you. And the better decisions you can make, the higher your quality of life will be. So ask your rheumatologist whatever it is you want to know. The only stupid question is the one you don’t ask.

FAQs

What happens at your first appointment with a rheumatologist? ›

Your doctor will rely on a combination of your medical history, a thorough physical exam and sometimes lab or imaging tests to reach a diagnosis. Medical history. This is information about current or past illnesses, surgeries and allergies as well as any medications you take.

Which body part is most often affected by rheumatoid arthritis? ›

RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).

What happens at a rheumatology assessment? ›

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

Is rheumatoid arthritis a big deal? ›

RA is a very serious autoimmune disease, in which your immune system mistakenly attacks your own body's tissues and causes severe joint pain, stiffness, severe fatigue, and sometimes deformity, usually in the hands, shoulders, knees, and/or feet. It affects men, women, and children of all ages.

What is destroyed in rheumatoid arthritis? ›

Rheumatoid arthritis (RA) is characterised by the presence of an inflammatory synovitis accompanied by destruction of joint cartilage and bone. Destruction of cartilage matrix results predominantly from the action of connective tissue proteinases released by RA synovial tissues, chondrocytes, and pannus tissue.

Does rheumatoid arthritis show up in blood test? ›

Blood tests

No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition. Some of the main blood tests used include: erythrocyte sedimentation rate (ESR) – which can help assess levels of inflammation in the body.

What assessment should be included in physical exam of rheumatoid arthritis? ›

During the physical exam, your doctor may look at, feel, and move each joint and evaluate it for: Swelling, warmth, and tenderness. Presence of fluid on the joint. Range of motion.

What autoimmune diseases does a rheumatologist diagnose? ›

Mayo Clinic rheumatologists have expertise in the treatment of inflammatory diseases of blood vessels (vasculitis) and systemic autoimmune connective tissue diseases (for examples, lupus, scleroderma).

Do Rheumatologists test for autoimmune diseases? ›

A rheumatologist is specifically trained to diagnose and treat autoimmune diseases. New biologic medications specifically target parts of the immune system to stop/turn off the inflammation causing damage.

What does it mean when you are referred to a rheumatologist? ›

Primary health care providers should consider referring patients to a rheumatologist if: You diagnose or suspect an inflammatory type of arthritis (e.g., rheumatoid arthritis, lupus, psoriatic arthritis), or to confirm a diagnosis. A patient needs a management plan for a type of inflammatory arthritis.

Why does my rheumatologist need a urine sample? ›

In this test, a urine sample is studied for protein, red blood cells, white blood cells, and bacteria. These abnormalities may indicate kidney disease, which may be seen in lupus as well as several rheumatic conditions. Some medications used to treat arthritis also can cause abnormal findings on urinalysis.

Can you live with rheumatoid arthritis without medication? ›

Can you live with rheumatoid arthritis without medication? Since RA is a progressive disease, you cannot live with it without medical treatment. If you do, the symptoms will gradually get worse and become disabling. There are some natural remedies that you can use to help with some symptoms relief.

What triggers rheumatoid arthritis flare ups? ›

Overexertion, poor sleep, stress or an infection like the flu can all set off RA symptoms. With a predictable flare you'll temporarily feel worse, but your symptoms will resolve in time. Unpredictable flares have more uncertainty associated with them.

Is rheumatoid arthritis worse than arthritis? ›

Two of the most common types are rheumatoid arthritis (RA) and osteoarthritis (OA). OA is more common than RA. Both involve inflammation in the joints, but RA causes much more inflammation.

What joints does rheumatoid arthritis affect first? ›

RA tends to affect many joints at once. Often, symptoms first appear in the small joints of the middle fingers and in the bases of the hands and toes. It usually occurs in the same joints on both sides of the body.

What is the most common complication of rheumatoid arthritis? ›

If you have rheumatoid arthritis, you're at a higher risk of developing cardiovascular disease (CVD). CVD is a general term that describes conditions affecting the heart or blood vessels, and it includes life-threatening problems such as heart attack and stroke.

How do I know if my rheumatoid arthritis is getting worse? ›

Signs Your RA Is Progressing

Flares that are intense or last a long time. Diagnosis at a young age, which means the disease has more time to become active in your body. Rheumatoid nodules -- bumps under your skin, often around your elbows. Active inflammation that shows up in tests of joint fluid or blood.

How quickly does rheumatoid arthritis spread? ›

The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days. The symptoms vary from person to person. They may come and go, or change over time. You may experience flares when your condition deteriorates and your symptoms become worse.

What does rheumatoid arthritis in the spine feel like? ›

Stiffness and loss of flexibility in the spine, such as being unable to straighten your back or turn your neck. Swelling and tenderness over the affected vertebrae. Feeling of grinding when moving the spine. Pain, swelling and stiffness in other areas of the body (especially in inflammatory arthritis)

What are the 7 diagnostic criteria for RA? ›

The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric ...

What test must be done to confirm diagnosis of RA? ›

Doctors may use x-rays to monitor the progression of the disease or to rule out other causes for the joint pain. Magnetic resonance imaging (MRI) and ultrasound may help diagnose rheumatoid arthritis in the early stages of the disease.

What is the latest treatment for rheumatoid arthritis? ›

The current gold standard treatment for rheumatoid arthritis combines a monoclonal antibody and TNF (tumor necrosis factor) inhibitor called adalimumab with a folic acid antagonist called methotrexate.

What is considered a high level of rheumatoid factor? ›

A level above 20 suggests the possibility of RA. As with rheumatoid factor, some people with positive anti-CCP antibody will not have RA, but this test is somewhat more specific for RA than the rheumatoid factor. The higher the levels of anti-CCP antibody, the more likely it is to suggest RA.

What is the most definitive test for rheumatoid arthritis? ›

Anti-CCP antibody test (ACCP or CCP). This test is for a type of autoantibody called cyclic citrullinated peptide (CCP) antibodies, which can be found in the blood of 60% to 80% of people with rheumatoid arthritis.

What is the most common physical manifestation in a resident with rheumatoid arthritis? ›

Signs and symptoms of rheumatoid arthritis may include: Tender, warm, swollen joints. Joint stiffness that is usually worse in the mornings and after inactivity. Fatigue, fever and loss of appetite.

What is the marker for rheumatoid arthritis? ›

The main clinically useful biologic markers in patients with RA include rheumatoid factors (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

What labs would be abnormal with autoimmune disease? ›

These include the complete blood count (CBC), urine analysis (UA), sedimentation rate (ESR), C-reactive protein (CRP), comprehensive metabolic panel (CMP), and muscle enzymes. In the CBC, we are looking for an anemia of inflammatory disease which can develop.

What autoimmune disease does a rheumatologist treat? ›

Mayo Clinic rheumatologists have expertise in the treatment of inflammatory diseases of blood vessels (vasculitis) and systemic autoimmune connective tissue diseases (for examples, lupus, scleroderma).

What is the most significant blood test to diagnose rheumatoid arthritis? ›

No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition. Some of the main blood tests used include: erythrocyte sedimentation rate (ESR) – which can help assess levels of inflammation in the body.

What is a positive test for rheumatoid arthritis? ›

A positive rheumatoid factor test result indicates that a high level of rheumatoid factor was detected in your blood. A higher level of rheumatoid factor in your blood is closely associated with autoimmune disease, particularly rheumatoid arthritis.

How does rheumatoid arthritis affect the urinary system? ›

In general, people with autoimmune diseases such as Rheumatoid Arthritis have a higher risk of lower urinary tract symptoms. Studies have also shown that there is a link between Rheumatoid Arthritis and bladder pain syndrome/interstitial cystitis. Interstitial cystitis causes urinary urgency and frequency.

How do doctors tell the difference between arthritis and rheumatoid arthritis? ›

The main difference between osteoarthritis and rheumatoid arthritis is the cause behind the joint symptoms. Osteoarthritis is caused by mechanical wear and tear on joints. Rheumatoid arthritis is an autoimmune disease in which the body's own immune system attacks the body's joints.

Does rheumatoid arthritis make you feel generally unwell? ›

People with rheumatoid arthritis typically have several permanently inflamed joints. The inflammation inside the body can lead to general physical weakness, drowsiness and exhaustion. This feeling of extreme tiredness is also called "fatigue." Some people find this to be the worst symptom of the disease.

Do you feel sick with rheumatoid arthritis? ›

Rheumatoid arthritis (RA) is an autoimmune condition that mainly affects a person's joints. However, RA can also cause symptoms that affect the gastrointestinal (GI) system, such as nausea, indigestion, and abdominal pain.

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