Rheumatologist 101 => What do I ask?

So I know many of you have posted this exact discussion in the past… BUT humor me, this will be my first appointment. My mind is racing and I need help prioritizing. I read the book that Seenie suggested. Psoriatic Arthritis (the facts), I feel confident about understanding the pathophysiology of the disease, medication options, and research that has been completed. I do not have these sort of questions. I am not sure where to go with this… Focus me! Help!

Hi, SS,

It's understandable to be nervous about your first visit to a new doc, especially a new doc in a new specialty. You are on target to be prepared with a list of things to discuss.

I think one of the biggest mistakes I made when seeing a new rheumy for the first time was to expect too much. Your first visit will include a lot of evaluation and assessment, and may not yield a lot of answers. The rheumy will ask what your symptoms are, where your pain is. Be specific about exactly which joints hurt--instead of "my hands," you will need to say, "the first joint of my index finger." He may ask what type of pain you have--throbbing, burning, dull, piercing. He also may ask if you notice swelling or redness in your joints.

Be prepared to answer a lot of questions about your medical history, and the history of family members, too. Tell the rheumy what you have tried for relief in the past, as well as what worked and what didn't work. Is here anything that makes your pain worse, or is it worse after rest or after activity? Take a list of all medications, supplements, or anything else you take on a regular basis--including non-prescription drugs. A good rheumatologist will do some poking and prodding, and it may be uncomfortable. You may be sent for blood work, x-rays or other lab or imaging.

It seemed like I always wanted to walk away from a new doc with a miracle plan, and was disappointed when it didn't happen. But it takes time for a new doc to learn how your illness affects you and what works. If tests are ordered, he may not want to offer much until he sees the results.

Good questions might include

Do I have arthritis? (Other illnesses can cause joint pain.)

What kind of arthritis do I have? What makes you suspect this type of arthritis?

What is the treatment plan?

If this treatment plan doesn't work, what will be the next step?

Is there anything I can do at home that will help--diet, applications of heat or ice, exercise, rest, weight loss?

If they aren't ordered, would there be any benefit to getting x-rays, trying physical therapy?

If you are prescribed medication, you might ask what the possible side effects are and what to do if you experience them. I also ask what to do if I forget a medication. Can I take it late? How late? Should I wait for the next dose?

If it's a possibility, can I get pregnant while I am taking this medication?

Are there any research programs I might be able to participate in?

Is there any reading you can suggest that will help me better understand what's going on with me?

It takes time for you to get to know your rheumy, too. Above all, you need a doc who listens, tries to understand, offers reasonable suggestions for improvement and educates you about your illness and treatment. I hope your first visit goes well! Good luck!

It sounds like you know how the disease works so my questions would be more focused on how the doctor is going to help you manage your symptoms and have a better quality of life. Some doctors treat with steroids, some want you on MTX for an extended period before trying other meds. What are your priorities - make sure they match up with your rheumatologist.

It sounds like you are really prepared. I was in a BAD BAD place when I first saw my rheumatologist - I had a long list of questions and I cried. Good luck to you!