What to Expect at a Rheumatology Appointment: Your First Visit

By Linda Rath | July 11, 2022

Your joints have been sore and stiff for months, so you’ve decided to see an arthritis specialist, or "rheumatologist" — a doctor who specializes in musculoskeletal diseases and autoimmune disorders — for the first time. Though you might not get a final diagnosis right away, it’s important to start the process; early diagnosis and treatment are the keys to good outcomes. Still, first appointments are stressful. You’re building a relationship with them and a lot of information is packed into very little time. Knowing what to expect — and being prepared — can help you make the most of your visit.

Getting a Diagnosis

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. Your doctor will also ask about the health of close family members. This is important because some types of arthritis have a genetic component. When you make your appointment, ask if you can download and fill out your medical history forms in advance. This saves valuable time during your visit and allows you to check old medical records or learn more about family health problems.
• Physical exam. This is often the most important part of the visit. Your doctor will examine your joints for swelling, tenderness and other signs of inflammation.  Finding where and how you hurt is important because different types of arthritis affect different parts of the body and may come with other symptoms, such as a rash or eye inflammation.
• Lab tests. Blood tests look for inflammation markers and antibodies — small proteins in the blood that are common in some types of arthritis. For example, anti-cyclic citrullinated peptide (anti-CCP) is an autoantibody present in about 60% to 70% of people with rheumatoid arthritis (RA); anti-nuclear antibodies (ANA) may be a sign of lupus, though perfectly healthy people can have ANA antibodies, too. If your symptoms suggest gout, your doctor will check your uric acid levels and may analyze fluid from the joint that hurts.
• Imaging tests. An X-ray is the most common diagnostic imaging test for arthritis. It’s used to identify structural changes such as bone erosions and cartilage damage. Conventional X-rays aren’t particularly helpful in early stages of arthritis before damage is clearly visible. In recent years, ultrasound — another noninvasive and relatively inexpensive test — has proved effective for detecting early inflammatory changes in joints. For many types of arthritis, MRI and CT scans, which are more expensive, may not be needed.

Waiting for a Diagnosis

Don’t be discouraged if you don’t get a diagnosis right away. Your doctor may wait for the results of lab and imaging tests to make a final call. Also, many autoimmune disorders are challenging and time-consuming to figure out. Diagnosis of ankylosing spondylitis (AS), a type of arthritis that affects the low back and spine, can take years, especially when patients are not referred to a rheumatologist. The chance that you’ll experience anything like this is small, however, since you’re seeing an arthritis specialist. Until you do get a definitive diagnosis, your doctor will likely treat your symptoms and suggest ways to reduce pain and inflammation.

Preparing for Your Visit

Think of your first rheumatology appointment as an important meeting. The more prepared you are, the more you’ll get out of the visit. Here’s what you can do:

• Keep a symptom log. Try to be as specific as you can, describing not only which joints hurt but also what the pain feels like (throbbing, burning, sharp, achy, constant, intermittent) and the circumstances when it’s better or worse. If you have other symptoms, like swelling, limited ability to move the joint or a rash, describe those in detail, too. Record your symptoms in a notebook, on your computer or an app on your phone.
• Take a list of your medications. This includes prescription and over-the-counter drugs as well as supplements and herbs. A medication list is important because some arthritis drugs react badly or are less effective combined with other meds.
• Print out a detailed medical history. If you can’t fill out your medical history ahead of time, write down all your problems you can remember — surgeries, ailments, broken bones as well as allergies — when they happened and how they were treated. With this, you won’t have to wrack your brain for details in your doctor’s waiting room.
• Ask questions. You won’t have time to address every question at your first visit, so start with the most important ones, including costs. If your doctor can’t tell you the cost of a test or treatment, ask them to find out. Then make sure your insurance company will cover it.
• Take someone you trust. A close friend or family member can be a great help at a first appointment. You’ll be bombarded with a lot of new information that can seem overwhelming. Someone else may hear things you miss or have questions you forget to ask and take notes for you. Recording the conversation with your doctor may also help. Check about pandemic protocols before you go.
• Understand and expect patient-centered care. The most productive doctor-patient relationship is one of mutual trust, respect and shared decision-making. Your doctor should tell you about all possible options, their potential costs and side effects. Together, you decide on the approach that aligns most closely with your values and goals. Many studies have shown that when patients are treated as a partner and their wishes respected, they’re more likely to stick with treatment and have much better overall outcomes.