What to expect at your initial rheumatology appointment

The initial appointment involves a thorough evaluation of your medical history, a comprehensive physical exam, and may include ordering diagnostic tests. Because many rheumatic and autoimmune conditions have similar symptoms, your rheumatologist will gather extensive information to make an accurate diagnosis.

1. Detailed medical history

The rheumatologist will ask you lots of questions to fully understand your condition. Being prepared with detailed information is key. You should be ready to discuss:

Your symptoms: When they started, what they feel like (e.g., sharp, dull, achy), their severity, and what makes them better or worse. A written symptom journal can be helpful.

Your personal medical history: Past illnesses, surgeries, and previous diagnoses and treatments.

Family medical history: This is important because many rheumatic diseases, like rheumatoid arthritis and lupus, can have a genetic component.

Current medications and supplements: A full list of everything you are taking, including over-the-counter drugs, vitamins, and supplements.

2. Comprehensive physical exam

The exam will focus on the specific areas of your body experiencing symptoms but may be more extensive if multiple organs are affected. The rheumatologist will:

Examine your joints for tenderness, swelling, and warmth.

Evaluate your range of motion and flexibility by asking you to bend and move.

Look for other signs of rheumatic disease like skin rashes, nodules (firm bumps under the skin), or changes to your nails.

3. Diagnostic testing

Based on your history and physical exam, the doctor may order several tests to aid in diagnosis. We have a lab on site for your convenience. We use local imaging facilities for x-rays, MRIs etc..

Blood tests: Look for inflammatory markers (like CRP and ESR) and specific autoantibodies associated with certain conditions.

Imaging tests: An X-ray can show changes in bones and joints, while an ultrasound or MRI can provide detailed images of soft tissues, inflammation, and cartilage.

Joint fluid analysis: If a joint is swollen, the doctor may remove a sample of synovial fluid to check for infection or crystals (like those seen in gout).

4. Diagnosis and treatment plan

It's important to remember that a definitive diagnosis may not be made during the first visit. Many rheumatic conditions require ongoing observation and tests; definitive diagnosis may take weeks or months on occasion.

Explanation: The rheumatologist will discuss their initial findings, what they suspect might be the cause of your symptoms, and if any further testing is needed.

Treatment options: They will present potential treatment strategies, including medications (NSAIDs, DMARDs, biologics), physical therapy, or lifestyle changes. Sometimes joint or soft tissue steroid injections may be necessary and will be administered in- office.

Monitoring and follow-up: You will discuss the next steps, including scheduling a follow-up appointment to monitor progress and review test results.