I am new to this and would like know what others look for in a good rheumatologist? What are good signs ( or big red flags) that they are doing their job? What can I expect at my first visit? I have seen one who did not do anything really and now going to see another, just looking for a little direction because I feel I have already wasted 5 months or more in pain…want to make this visit as efficient as possible. Do they do baseline X-rays/cts?
Different rheumies seem to have different methods. Mine is very hands on, and does x-rays very infrequently. No baseline imaging. Good signs? Same as with all doctors. The rheumy shouldn't be overly reliant on labs, should be hands on, should listen to your concerns. You shouldn't feel rushed, or not heard. I would also ask questions about urgent appointments. For example, my rheumy always has spots open for urgent appointments. If you're having a bad flare, it's much better to be able to see your own doctor than to have to go to Urgent care or the ER.
I wish you luck with this.
Wondering, your first appointment will go better if you have a solid understanding of this disease. I recommend a book under BOOK REVIEWS. The electronic version is a bargain, and if you don’t have a Kindle, you can get software for your pc or tablet that will allow you to be reading the book in just a few minutes. Asking good questions will make your rheumie sit up and take notice!
Make a list of questions! And if you have any pictures of intermittent symptoms like swollen joints, bring those too.
Other than that, I second everything that Stoney said. Some docs take baseline x-rays, others don’t. My own feeling is that I would want x-rays periodically. Here’s why. Some of us have high pain tolerance. At my intake appointment, my rheumatologist ordered x-rays of my hips. (I already had two knee replacements and erosions in my feet.) Those x-rays revealed mild-moderate damage. For a year, I was on this DMARD and that, and at my subsequent appointments the doctor judged my disease by twiddling my fingers and toes. After a year of DMARD experimentation, I asked for a biologic. I just did not feel well. She refused, saying that my disease was mild, which I didn’t think was right. (But then, I’m not a rheumatologist, so what did I know?) Shortly after that, I developed hip pain, had an x-ray and was told that I needed a hip replacement. That was just over a year after diagnosis, and a subsequent second-opinion consult at a specialty clinic placed me in the “severe” category.
I’m not saying that everyone needs x-rays at every appointment, but having the baseline x-ray helped track the progression of my disease. And it was rapid and severe, despite the fact that I was not complaining a lot about pain. As far as rheumie #1’s diagnostic technique went, she might have come closer to the mark if –
- She had considered more than the state of my finger and toe joints
- She had been more interested in how I was feeling (which seemed to be irrelevant to her)
So in my book, baseline x-rays are a good thing. And I want a rheumatologist who looks all aspects of my health, including mental. And you need to feel confidence in your rheumie. If you don’t feel good about what’s happening in that consultation room, it’s time to find youurself another.
I switched rheumies, and was started on a biologic asap, but not soon enough to prevent the irreparable damage that had happened in the meanwhile to my feet.
I guess being with a rheumatologist in whom you have confidence is probably the most important thing of all. And don’t be afraid to seek a second opinion.
When is your aappointment? Let us know how it goes.
Wondering, here’s a good read for you –
http://discussion.livingwithpsoriaticarthritis.org/profiles/blogs/saw-my-rheumy-what-a-difference?xg_source=activity
Osteophytes, or syndesmophytes? I would ask for a clarification. Osteophytes can be a lot of things, what kind of osteophytes is huge. The formation of syndesmophytes is what we worry about most with PsA. "Disc damage is pretty common with anyone over 40 as is some osteophytes.