How to Prepare for Your Next Rheumatologist Visit

What a rheumatologist does during your first visit

Your first visit may be longer than subsequent visits. Expect it to last about an hour. Your doctor will want to do a thorough examination and talk with you about all of your symptoms.

Note: Many of these tools won’t be available if you’re using telehealth services, so speak with your doctor about how they want to see you for your visit. If you’re doing a telehealth session, make sure you’re prepared with a stable connection and have all of your health and medication information on hand.

Physical examination

You can expect a physical exam to assess your general health and any joint swelling or other symptoms that can indicate inflammation in your joints and other areas. This could include swelling, warmth, redness, rashes, or nodules (a growth of abnormal tissue).

They may ask you to move or stretch in certain ways to test for flexibility and mobility. If you feel any pain, let them know.

Lab testing

Lab tests, including urine, blood, or joint fluid tests, may be ordered to test for various factors, antibodies, and genetic markers of specific conditions. Here are a few examples for which you may be tested:

• anti-cyclic citrullinated peptides (anti-CCP) antibodies
• anti-nuclear antibody (ANA)
• complete blood count (CBC)
• c-reactive protein (CRP)
• erythrocyte sedimentation rate (ESR or sed rate)
• HLA-B27 genetic markers
• rheumatoid factor
• synovial fluid analysis
• various vitamins and minerals such as calcium and vitamin D

Imaging tests

Your doctor may order imaging tests, such as X-ray or CT and MRI scans, to achieve a correct diagnosis or gain more insight into your condition and its progress.

Diagnosis and a treatment plan

You may not get a diagnosis right away, and you should be aware that many autoimmune disorders may take a number of years to fully evolve. In many instances, symptomatic treatment is initiated before a definitive diagnosis can be made.

If a working diagnosis can be made, you’re likely to return for more visits to determine a final diagnosis and begin a treatment plan to meet your needs.

This could include:

• Medications. These could include nonsteroidal anti-inflammatory agents (NSAIDs), disease-modifying antirheumatic drugs (DMARD), corticosteroids, or biologic response modifiers (biologics).
• Exercise, physical therapy, or occupational therapy. Remaining active and moving muscles and joints are often key to effective treatment. Your doctor may refer you to specialists in these areas.
• Lifestyle changes. Dietary, weight management, pain management, mental health support, and other wellness goals may be included in your treatment plan.

It’s important to remember that you’re visiting a doctor, but you’re also establishing a long-term relationship with them — since many diseases, even when well-managed, may be lifelong.

Tips for being prepared at your next rheumatologist visit

Keep a log of your symptoms

Your rheumatologist can’t treat you without knowing how you feel. Keep a journal of your day-to-day symptoms to share with them. Include this information:

• Which joints hurt?
• When did the pain start? What were you doing when it started?
• What does it feel like — sharp, dull, throbbing, achy, tender?
• How severe is the pain on a scale of 1 to 10?
• How has it changed over the last few days or weeks?
• How does the pain affect your daily routine?
• Is it worse when you get up in the morning?
• Does anything help the pain, such as over-the-counter (OTC) pain or anti-inflammatory medication or exercise?
• Do you have any other symptoms that may seem related?
• Do you know of anyone else in your family living with arthritis, autoimmune diseases, or other rheumatoid conditions?

Your answers to these questions can help your doctor develop a more targeted treatment plan for you.

Make a list of questions for your doctor

Overloaded schedules may force doctors to spend just 15 minutes, on average, with each patient. That’s not a lot of time when you consider all the issues you’ll need to discuss.

Make the most of the time you have with your rheumatologist by writing up a list of questions beforehand. Carry around a small notebook or use your smartphone’s notepad to jot down questions as you think of them.

Some questions might include:

• Do you think I’m on the best treatment for my symptoms?
• What kinds of improvements should I expect to see with my treatment?
• What other treatment options are available?
• What do you plan to do if I don’t see any improvement, or if my symptoms get worse?
• How long should I stay on this medication?
• What should I do if I have side effects from my treatment?
• What can I do if I have trouble sleeping through the night?
• Could I benefit from seeing any other healthcare providers, like a physical therapist, pain management specialist, or nutritionist?
• Could I benefit from any clinical trials for new treatments?

Bring a list of your medications

Keep a running list of all the drugs you take.

Also, include medications you take to treat other conditions. List any herbal supplements or vitamins that are part of your daily regimen as well. Write down the dose, and when in the day (morning or evening) you take each medication.

You could also put all the medications in a bag and bring them with you to your appointment, although a detailed list with dosages will take less time for your doctor to review.

Knowing exactly which medications you take will help your doctor make changes to your regimen or add a new prescription if you need it. Your doctor can see right away if, for example, a new medication might interact with something you already take or if you’re on too high a dose.

Recruit a friend or family member

Ask your partner, trusted friend, or family member to come with you to your appointment (as long as pandemic rules allow it). They can take notes so you can stay focused on the conversation with your doctor.

They can also remind you of any questions you’ve forgotten to ask or issues you were planning to bring up. You’ll also have a supportive person to champion you if needed.

Find out which tests you need

Your doctor might use imaging tests like an X-ray or MRI scan to look for changes in your bones or joints. For some of these tests, you might need to prepare by not eating or drinking for several hours, or by removing anything containing metal, such as hearing aids or dentures.

Make sure you know what you need to do to prepare at least a few days before your test.

Expand your treatment discussion

Because of time constraints, your doctor might keep the focus of your appointment on medical therapies. Yet lifestyle changes can also help you manage the symptoms of your condition.

If you haven’t covered these topics yet with your doctor, bring them up at your next appointment:

• how often you should exercise, and what types of workouts are best and safest for you
• whether you should use heat and/or cold, and if so, how often
• if you smoke, what methods you can try to help you quit
• how to achieve and maintain a healthy weight for your body, if recommended by your doctor
• how to get emotional and community support if you need it

Takeaway

Living with a painful chronic condition can be as hard on your mind as it is on your body. Don’t neglect your emotional state.

If your rheumatologist can’t address your mental health needs, ask for a referral to a psychologist, psychiatrist, or counselor.

Living with a rheumatic disorder can be hard, but it can also be successfully managed with the right treatment. Being prepared and helping your rheumatologist make the most of the time they have with you is key to the best outcome.