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) Rheumatoid arthritis - causes, symptoms, diagnosis, treatment, pathology

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.

(Video) Preparing for your rheumatology appointment

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) Management of Rheumatoid Arthritis: Finding the Right Rheumatologist

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) Rheumatoid Arthritis implications throughout the lifespan

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 a rheumatologist does at first visit? ›

“The first visit will include a physical exam in which your rheumatologist will search for joint swelling or nodules that may indicate inflammation,” says Dr. Smith. “Lab tests, such as X-rays and blood work, may also supply pieces of the puzzle to assist your rheumatologist in arriving at your diagnosis.”

What happens at rheumatology appointment? ›

Your first appointment in the rheumatology department will likely be with a consultant rheumatologist, who will perform clinical assessment and physical examination. Your rheumatologist may order a few tests to further evaluate your condition. These would include blood tests, x-ray and other imaging.

What does a rheumatologist look for? ›

A rheumatologist is an internist or pediatrician who received further training in the diagnosis (detection), and treatment of diseases that affect the muscles, bones, joints, ligaments, and tendons. These diseases can cause pain, swelling, stiffness, and potentially cause joint deformities.

What can I expect with a rheumatoid arthritis diagnosis? ›

Rheumatoid arthritis can cause pain, swelling and deformity. As the tissue that lines your joints (synovial membrane) becomes inflamed and thickened, fluid builds up and joints erode and degrade. Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints.

How do I prepare for a rheumatology appointment? ›

Tips for being prepared at your next rheumatologist visit
  1. Keep a log of your symptoms. ...
  2. Make a list of questions for your doctor. ...
  3. Bring a list of your medications. ...
  4. Recruit a friend or family member. ...
  5. Find out which tests you need. ...
  6. Expand your treatment discussion.

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.

Why would your doctor refer you 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.

What does rheumatic pain feel like? ›

The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.

What are the symptoms of rheumatic disease? ›

What are the symptoms of arthritis and other rheumatic diseases?
  • Joint pain.
  • Swelling in a joint or joints.
  • Joint stiffness that lasts for at least 1 hour in the early morning.
  • Chronic pain or tenderness in a joint or joints.
  • Warmth and redness in the joint area.
  • Limited movement in the affected joint or joints.

What do you wear to a rheumatologist? ›

Garments such as shorts/pants that are easily pulled up to the hip and short sleeve shirts that are loose fitting are often helpful in allowing your physician to examine all areas necessary. If your garments are too tight or bulky, you may be asked to change into a medical examination gown.

What questions should I ask my rheumatologist? ›

Questions to Ask Your Rheumatologist
  • Are my joint symptoms likely caused by my inflammatory arthritis? ...
  • What are the most common causes of my inflammatory arthritis occurring outside of my joints? ...
  • Do I need to be on a DMARD? ...
  • What can I take for flares of arthritis symptoms?
2 Jul 2019

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 are the 5 classic signs of inflammation? ›

Based on visual observation, the ancients characterised inflammation by five cardinal signs, namely redness (rubor), swelling (tumour), heat (calor; only applicable to the body' extremities), pain (dolor) and loss of function (functio laesa).

How serious is rheumatoid arthritis? ›

Rheumatoid arthritis (RA) has many physical and social consequences and can lower quality of life. It can cause pain, disability, and premature death. Premature heart disease. People with RA are also at a higher risk for developing other chronic diseases such as heart disease and diabetes.

What does a rheumatoid arthritis flare up feel like? ›

An RA flare can involve an exacerbation of any symptom of the disease, but most commonly it's characterized by intense pain and stiffness in the joints. Flares are often severe enough to interfere with everyday tasks, such as: getting dressed, grooming, and bathing.

What medication does a rheumatologist prescribe? ›

The currently available drugs include:
  • Methotrexate (Rheumatrex®, Trexall®)
  • Hydroxychloroquine (Plaquenil ®)
  • Sulfasalazine (Azulfidine®)
  • Leflunomide (Arava®)
  • Tumor Necrosis Factor Inhibitors— etanercept (Enbrel®, adalimumab (Humira ®), and infliximab (Remicade®), certolizumab pegol (Cimzia®), golimumab (Simponi®)

What blood tests are used to detect rheumatoid arthritis? ›

Some of the main blood tests used include: erythrocyte sedimentation rate (ESR) – which can help assess levels of inflammation in the body. C-reactive protein (CRP) – another test that can help measure inflammation levels.

What are the 4 stages of rheumatoid arthritis? ›

The four stages of rheumatoid arthritis are known as synovitis, pannus, fibrous ankylosis, and bony ankylosis.
  • Stage I: Synovitis. During stage I, you may start having mild symptoms, including joint pain and joint stiffness. ...
  • Stage II: Pannus. ...
  • Stage III: Fibrous Ankylosis. ...
  • Stage IV: Bony Ankylosis.
12 Oct 2021

What type of arthritis is the most painful? ›

Rheumatoid arthritis can be one of the most painful types of arthritis; it affects joints as well as other surrounding tissues, including organs. This inflammatory, autoimmune disease attacks healthy cells by mistake, causing painful swelling in the joints, like hands, wrists and knees.

How long do Rheumatology blood tests take? ›

It may take 2 to 3 days for results to be available.

What if my RA test is negative? ›

If these tests come back negative, but the patient is experiencing the signs and symptoms of rheumatoid arthritis, this is considered 'seronegative rheumatoid arthritis'. (An estimated 20% of RA patients are seronegative.) Although, either test (RF or anti-CCP) can still come back as positive when RA is not present.

Does arthritis show up on an xray? ›

Conventional Radiographs – Routine X-ray Examinations

Specifically, an X-ray of a joint with osteoarthritis will show a narrowing of the space between the bones of the joint where the cartilage has worn away, as shown in the image below. Anteroposterior (front to back) X-ray image of the knee showing osteoarthritis.

How does a rheumatologist diagnose arthritis? ›

The diagnosis of rheumatoid arthritis can't be established with just one test. Instead, rheumatologists rely on a combination of your medical history, a physical exam, laboratory tests, and sometimes imaging tests to pinpoint the disease.

What are rheumatic diseases? ›

Rheumatic disease is an umbrella term that refers to arthritis and several other conditions that affect the joints, tendons, muscle, ligaments, bones, and muscles (arthritis refers to disorders that mainly affect the joints).

Does rheumatoid arthritis hurt all day? ›

You may have difficulty getting out of bed or walking in the morning because of stiff and painful ankles, knees, or feet. This stiffness is usually worse in the mornings and can last for 45 minutes or more. RA can also trigger swelling in the affected joints.

How do I know if I have osteoarthritis or rheumatoid arthritis? ›

RA is symmetrical, where a patient feels symptoms in the same spot on both sides of the body, often in the joints in the feet and hands. Osteoarthritis, in contrast, begins in an isolated joint, often in the knee, fingers, hands, spine and hips. While both sides may hurt, one side is more painful.

Which is worse osteoarthritis or rheumatoid arthritis? ›

The two conditions can cause similar symptoms, but they have different causes and treatments. OA usually affects fewer joints, and its symptoms are generally limited to the joints. The progression of RA is more difficult to predict, and it can cause more widespread symptoms.

Is rheumatoid arthritis considered a terminal illness? ›

So is rheumatoid arthritis fatal? RA itself is not fatal. However, studies have shown that RA can shorten a patient's lifespan. This is because RA can cause dangerous complications and inflammation, which affect your overall health.

What is difference between arthritis and rheumatism? ›

Arthritis, derived from Greek for “disease of the joints,” is the chronic or acute inflammation of joints, which is often accompanied by structural damage and pain. In contrast, rheumatism is an informal term used to describe joint diseases or syndromes. Medical literature does not generally use the term rheumatism.

What is the difference between rheumatism and rheumatoid arthritis? ›

Rheumatoid arthritis is an inflammatory autoimmune condition that leads to swelling in the joints. It may also cause a fever and other symptoms. When people use the word “rheumatism,” they often mean rheumatoid arthritis. When people use the word “arthritis,” they are sometimes referring to osteoarthritis.

What medication does a rheumatologist prescribe? ›

The currently available drugs include:
  • Methotrexate (Rheumatrex®, Trexall®)
  • Hydroxychloroquine (Plaquenil ®)
  • Sulfasalazine (Azulfidine®)
  • Leflunomide (Arava®)
  • Tumor Necrosis Factor Inhibitors— etanercept (Enbrel®, adalimumab (Humira ®), and infliximab (Remicade®), certolizumab pegol (Cimzia®), golimumab (Simponi®)

Why would you be referred to a rheumatologist? ›

"Your doctor refers you to a rheumatologist when he or she suspects you have a systemic, autoimmune condition," says Dr. Ganti. "These are diseases in which your immune system is attacking your own body. In the process, inflammation occurs in different organ systems within the body, leading to a variety of symptoms."

What questions should I ask my rheumatologist? ›

Questions to Ask Your Rheumatologist
  • Are my joint symptoms likely caused by my inflammatory arthritis? ...
  • What are the most common causes of my inflammatory arthritis occurring outside of my joints? ...
  • Do I need to be on a DMARD? ...
  • What can I take for flares of arthritis symptoms?
2 Jul 2019

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 best painkiller for arthritis? ›

Pain relief medicines
  • Paracetamol. If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol to begin with. ...
  • Non-steroidal anti-inflammatory drugs (NSAIDs) ...
  • Opioids. ...
  • Capsaicin cream. ...
  • Steroid injections.

What is the most successful drug for rheumatoid arthritis? ›

Methotrexate is one of the mainstays of treatment for inflammatory forms of arthritis. It not only reduces pain and swelling, but it can actually slow joint damage and disease progression over time. That's why methotrexate is known as a disease-modifying antirheumatic drug (DMARD).

What is the strongest anti-inflammatory medication? ›

What is the strongest anti-inflammatory medication? Research shows diclofenac is the strongest and most effective non-steroidal anti-inflammatory medicine available.10 Diclofenec is sold under the prescription brand names Cambia, Cataflam, Zipsor, and Zorvolex.

What are the symptoms of rheumatic disease? ›

What are the symptoms of arthritis and other rheumatic diseases?
  • Joint pain.
  • Swelling in a joint or joints.
  • Joint stiffness that lasts for at least 1 hour in the early morning.
  • Chronic pain or tenderness in a joint or joints.
  • Warmth and redness in the joint area.
  • Limited movement in the affected joint or joints.

What blood tests are used to detect rheumatoid arthritis? ›

Some of the main blood tests used include: erythrocyte sedimentation rate (ESR) – which can help assess levels of inflammation in the body. C-reactive protein (CRP) – another test that can help measure inflammation levels.

How does a rheumatologist diagnose arthritis? ›

The diagnosis of rheumatoid arthritis can't be established with just one test. Instead, rheumatologists rely on a combination of your medical history, a physical exam, laboratory tests, and sometimes imaging tests to pinpoint the disease.

What procedures can a rheumatologist perform? ›

Tests and procedures
  • Bone scan.
  • Cortisone shots.
  • Dual energy CT scan.
  • Hip replacement.
  • Joint scan.
  • Knee replacement.
  • MRI.
  • Nailfold videocapillaroscopy.
1 Apr 2020

How would you describe rheumatoid arthritis pain? ›

A person with RA may feel intense pain in their joints during flares. This may feel like sustained pressure, a burning sensation, or a sharp pain. However, people with RA may also experience periods of remission when they feel few to no symptoms. In addition to causing pain in the joints, RA can affect the whole body.

Can an xray show the difference between osteoarthritis and rheumatoid arthritis? ›

X-rays are a helpful tool for figuring out joint pain. Joints in RA look different than joints in OA. For example, there's less space between the bones in OA, and there is more bone erosion in RA. That said, X-rays can be normal in either disease if it's early.

Videos

1. The Rheumatology Exam
(Top Hat Tutorials)
2. Understanding your ESR result: A Rheumatologist Explains
(Connected Rheumatology)
3. Arthritis in the Hands//Top 5 Facts to know when you have hand arthritis
(Connected Rheumatology)
4. How is Rheumatoid Arthritis Diagnosed? | Johns Hopkins Rheumatology
(Johns Hopkins Rheumatology)
5. Ask a rheumatologist webinar with Professor Catherine Hill
(Arthritis SA)
6. Seronegative Rheumatoid Arthritis?
(Rheumatologist OnCall - Dr. Diana Girnita)
Top Articles
Latest Posts
Article information

Author: Duane Harber

Last Updated: 12/25/2022

Views: 6041

Rating: 4 / 5 (71 voted)

Reviews: 86% of readers found this page helpful

Author information

Name: Duane Harber

Birthday: 1999-10-17

Address: Apt. 404 9899 Magnolia Roads, Port Royceville, ID 78186

Phone: +186911129794335

Job: Human Hospitality Planner

Hobby: Listening to music, Orienteering, Knapping, Dance, Mountain biking, Fishing, Pottery

Introduction: My name is Duane Harber, I am a modern, clever, handsome, fair, agreeable, inexpensive, beautiful person who loves writing and wants to share my knowledge and understanding with you.