A bit of joint pain or inflammation probably doesn’t ring any warning bells, but they might be symptoms of a severe underlying condition. After reading this post, you might want to schedule an appointment with your rheumatologist. Here, we’ll talk about:
○ The basics of rheumatology
○ An overview of the most common rheumatic conditions
○ How to make the most out of your first visit with a rheumatologist
So... What are the reasons to see a rheumatologist?
Let me take a tiny step back...
By a show of hands, who here has experienced:
○ Joint pain
○ Sun sensitivity
My guess, most of us have experienced at least one of these symptoms individually at some point in time, usually in response to a specific event. In that case, these symptoms aren’t too worrisome. Most can be fixed with a little TLC.
But did you know that all of these signs can occur simultaneously and can be related to one specific disease? If you were thinking a rheumatic disease, you’re right.
And even worse, they can become chronic and severe. That’s when things get worrisome and when you should see a rheumatologist.
When most or all of these symptoms happen concurrently, they point to a rheumatic disease, which targets the musculoskeletal system and the bones, joints, tendons, connective tissue, and more. Some common rheumatic diseases include:
○ Osteoarthritis (OA)
○ Rheumatoid Arthritis (RA)
○ Ankylosing Spondylitis
○ Sjogren’s Disease
○ Psoriatic Arthritis
You might be thinking:
"WHEN should I see a rheumatologist?", i.e.:
How bad do my symptoms have to be before I should see a rheumatologist?
Well.. if you suffer from any of these symptoms, ask yourself the following questions:
1. Do your symptoms temporarily improve and suddenly worsen?
2. Do you experience flare-ups with a particular symptom and have the flare-ups occurred more frequently and for longer periods of time?
3. Do your symptoms change in intensity or duration?
4. Do you have a family history of rheumatic disease?
5. Have you noticed any triggers relating to your symptoms?
If you said yes to any of these questions...
...It could be time to see a rheumatologist.
If the above didn't ring any bells and you're still thinking, “Why am I being referred to a rheumatologist?
Better yet, what is a rheumatologist?”
....Here is a quick introduction to rheumatologists for those who aren’t familiar with their practice.
A rheumatologist is a specialized medical doctor, specifically an internist or pediatrician. An internist focuses solely on adult disease while a pediatrician specializes in children' conditions.
Both types undergo approximately 8 grueling years of schooling (including undergraduate school, medical school, rheumatology residency, and rheumatology fellowship) and must pass a national board exam after completing all educational requirements.
The amount of education required to practice rheumatology should demonstrate the complex nature of these diseases!
How & When to See a Rheumatologist
If you think you might suffer from one of the diseases explained above (and in even more detail below - so stick around!), talk to your PCP first about seeing a rheumatologist.
Unfortunately, most rheumatoid diseases are complex in nature and difficult to diagnose, which is why your PCP will generally refer you to a rheumatologist for diagnosis.
Some insurance companies require a referral from your PCP to cover rheumatology office visits and treatments, so be sure to check your insurance policy for more details.
(There’s nothing worse than discovering insurance won’t cover a penny for necessary medical treatments after receiving treatment.)
Origins of Rheumatic Diseases
Now: to talk about the origins of rheumatic diseases.
First off, a small silver lining. Rheumatic diseases fortunately are not contagious.
Unfortunately, they are autoimmune disorders. Meaning, the immune system has gone haywire and misreads healthy tissue as diseased tissue. Aka, the enemy. Which activates the kill-mode for white blood cells. And like with any pathogen, the body kicks into high gear to kill the “enemy”. Only the enemy is actually a friend; the body is just somehow blinded to the fact that the tissue is actually healthy.
This results in inflammation, tenderness, sore and tired joints, and other symptoms (this is also why some people suffer from fatigue as well, since their body is essentially fighting itself 24/7).
Doctors still aren’t sure why the body malfunctions like this. But unfortunately, it means you’re likely stuck with a rheumatic disease indefinitely. This is one of the reasons why you should see a rheumatologist and why the rheumatologist should be your lifelong friend.
A Quick Overview of Rheumatic Conditions
Here is a brief overview of some of the most common rheumatic conditions and their specific symptoms.
1. Osteoarthritis (OA)
Unlike most rheumatic diseases, OA isn’t actually caused by a faulty immune system. Instead, it stems from cartilage decay, which prevents joints from moving smoothly and easily. This is why it is most commonly found in the knees, finger joints, hips, feet joints, and lower back.
Common symptoms for OA may include stiffness, pain when moving, and swelling. Typical diagnosis includes a physical exam, blood work, and an x-ray.
2. Rheumatoid Arthritis (RA)
Rheumatoid Arthritis (RA) occurs due to the immune system attacking healthy tissue and cells. While some stiffness in the joints can be due to aging, RA is not related to aging and can occur at any age.
Common symptoms are pain and swelling in joints (especially in correlating joints, like both knees or both wrists), issues with organs such as the eyes, fatigue, joint stiffness, and sometimes lupus. Diagnosis typically includes x-rays, biopsies testing joint fluid, and blood work measuring inflammation.
Lupus, also known as SLE, is another type of rheumatoid autoimmune disorder. Unlike the previous rheumatic disorders, lupus has a host of symptoms, including hair loss, fatigue, pain, swelling/redness, joint stiffness, inflammation, rashes (especially across the face), blood disorders like anemia, sun sensitivity, bluish fingers and toes when cold, and more.
For diagnosing lupus, doctors usually order urine tests and blood work testing for antinuclear antibodies, anti-double stranded DNA antibodies, and Anti-Smith antibodies.
4. Ankylosing Spondylitis
This one is sneaky because it doesn’t have the typical rheumatic symptoms. Instead, it begins as a gradual pain in the lower back region. This is because it is primarily active in the sacroiliac region, which is where the spine connects with the pelvis.
After the initial lower back pain, other symptoms include pain that travels up or down the spine, stiffness between the shoulders and neck, and back stiffness after laying down.
Ankylosing spondylitis is most common in young men. Diagnosis usually involves a physical exam, x-rays, and blood work testing for HLA-B27 proteins.
5. Sjogren’s Disease
Sjorgren’s disease is similar to ankylosing spondylitis in that it doesn’t have the usual stiffness and pain found in most rheumatic diseases. Instead, Sjogren’s disease causes areas of the body to dry out, like the mouth and eyes. Unlike ankylosing spondylitis, Sjogren’s is more common in women.
Dry mouth and eyes, gum disease and tooth decay, and swollen neck glands are typical symptoms and can be diagnosed by a skin biopsy in the mouth.
6. Psoriatic Arthritis
This is another autoimmune disorder that often co-exists with psoriasis. There are 5 different types, which can make it difficult to diagnosis. However, it generally targets the finger & toe joints and the spine & back. Similarly to RA, symptoms include stiffness and pain in swollen joints, inflammation, fatigue, and tendon pain.
Because there are 5 types of psoriatic arthritis, diagnosis testing can be quite intense. Diagnosis options include skin biopsies; blood work testing for C-reactive protein, rheumatoid factors, and erythrocyte sedimentation rates; joint fluid testing, and RA imaging tests.
Gout is one of the more familiar rheumatoid diseases. And it is not an autoimmune disorder, meaning it can happen suddenly to anyone.
What exactly is it?
It’s a build-up of uric acid crystals mainly in the toes and feet, causing intense and acute pain.
Obviously, hellish pain the feet and toes is a frequent symptom, but other symptoms may include pain in other joints, general aches in joints, swelling/inflammation, and joint stiffness.
To diagnose, your doctor will likely order blood work to measure uric acid levels, synovial fluid analysis, a complete blood count, and a test for antinuclear antibodies.
Essentially, scleroderma means hard skin. There are two types: localized and systemic. Children suffer from localized scleroderma more than systemic and this type toughens skin and all tissues below it. Like fat, bone tissue, muscles, and connective tissue.
Systemic scleroderma is more general (hence the word systemic) and targets skin, blood vessels, organs, muscles, and joints all over the body.
Besides hardening of the skin, common symptoms include calcium deposits, digestive issues, fatigued muscles, stiff/swollen joints, and dry mouth or eyes. Blood work typically tests for antinuclear antibodies, centromere antibodies, and Scl-70 antibodies.
So how do you know when to see a rheumatologist? If any of those descriptions seemed to fit your symptoms, it’s time to make an appointment.
Tips for Your First Visit
Now that we’ve covered what a rheumatology specialist is and reasons why you need to see the rheumatologist, let’s talk about deciding which rheumatologist to see.
After all, if you will be visiting the “rheu” frequently for the rest of your life, you need someone who can both effectively and efficiently treat you.
So once you arrive at the rheumatologist’s office for your first visit, here are tips and tricks to get the most out of your visit.
1. Ask Questions
When you see a rheumatologist for the first time, ask questions about anything. And everything! If you feel like it’s relevant, ask. If you don’t, still ask.
Here are some examples of questions to ask at the rheumatologist:
○ What’s your experience treating this rheumatic disease and what sort of treatment options are available?
○ What education and experience do you have that makes you qualified to treat my particular condition?
○ Have other rheu patients with my same diagnosis had success with your treatments?
○ How many treatments will I need before I see improvement?
For questions regarding an actual condition, here are some examples:
○ When I have pain in a joint, should I use it or rest it? And how do I treat it?
○ Do I need to change my diet or use any supplements?
○ What type of medications might I have to take?
○ How do I prevent feeling achy when I wake up in the morning?
2. Have A “Symptoms Notebook”
Document your symptoms before your first visit in a notebook so you can clearly describe your symptoms. Some important things to include could be:
○ What type of symptoms you experience (like stiffness in joints, pain, swelling, etc)
○ How often and when your symptoms occur (2x per week, every day, in the morning, at night, etc)
○ Include symptom descriptors (is the pain dull or throbbing, is there a burning sensation, etc)
○ Where you feel the symptoms (all over, arms, legs, in the muscles, joints, etc)
○ If you've noticed any triggers (like the swelling is worse after sitting down, the inflammation is worse after laying down, etc)
○ When you first noticed the symptoms.
3. Document The Visit
The first visit to the rheumatologist can be overwhelming, so bring a notebook, a recorder, or a friend so you can easily remember the conversation in the future.
And when the time comes for diagnosis, bring something or someone again so you can write out your treatment plan and what the doctor explained. Your rheumatologist might suggest several treatment options, so documenting the final one help ensure you're following the doctor's orders to a T.
Now, all that's left is to live your life to the best of your ability, in spite of your rheumatic condition.
Good luck and make this year your best one yet!
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