Ask the Expert: When Should You See a Rheumatologist?

by Dr. Alana B. Levine
12.4 Blog

Knowing when to see a rheumatologist can be tricky – especially if you don’t know what a rheumatologist is or what diseases they diagnose and treat! My own friends and family didn’t know much about this field when I chose to go into it and I’ve been in many social situations where I’ve introduced myself as a rheumatologist and have been met with blank stares in return.

So first off, a rheumatologist is a doctor who specializes in both musculoskeletal disorders and certain autoimmune conditions. In its simplest form, we can be described as “arthritis” doctors, but really we actually do much more. Here are some reasons to see a rheumatologist:

You have been diagnosed with arthritis or a rheumatic disease

There are over 100 types of arthritis and rheumatologists specialize in the care of many of these conditions. Examples of diseases that may be treated by a rheumatologist include rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), vasculitis, Sjogren’s syndrome, gout, scleroderma, antiphospholipid syndrome (APS), myositis, sarcoidosis, polymyalgia rheumatica (PMR), and temporal arteritis (or giant cell arteritis). We take care of many other rare diseases as well.

You have joint pain and/or swelling

Joint pain and swelling may be the first symptoms of rheumatic disease. We know that early diagnosis and treatment of arthritis are the best ways to ensure good outcomes in our patients. If you are suffering from joint symptoms, consider scheduling an appointment with a rheumatologist for an evaluation.

You have been told you have certain abnormal blood test results

Certain symptoms or complaints will prompt primary care doctors to order blood tests that may indicate the presence of rheumatic diseases. Examples of these blood tests include: antinuclear antibodies (ANA), rheumatoid factor (RF), and erythrocyte sedimentation rate (ESR). If you have tested positive for one of these tests, consider meeting with a rheumatologist to determine if your symptoms might indicate an underlying condition.

You are having trouble figuring out what’s wrong

Rheumatologists treat many rare diseases that are difficult to diagnose. We often act as detectives to help put together the pieces of a complex puzzle of symptoms and lab tests. Seeing a rheumatologist early on can help patients avoid waiting months to years before receiving a diagnosis. Gathering the clues and helping patients figure out what’s going on is one of my favorite things about being a rheumatologist.

I absolutely love the opportunity to help my patients figure out a diagnosis, teach them what to expect from their diseases, and devise treatment plans to get them feeling better. If any of the points listed above applies to you or a family member, consider scheduling an appointment with one of the rheumatologist at Hospital for Special Surgery or ask your primary care doctor to help find a rheumatologist near you.

Dr. Alana LevineDr. Alana B. Levine is a rheumatologist at Hospital for Special Surgery. She specializes in rheumatic autoimmune diseases including systemic lupus erythematosus, antiphospholipid syndrome, undifferentiated connective tissue disease and rheumatoid arthritis.

Topics: Rheumatology
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Joann Marino says:

I am looking for a dr that takes 1199 insurance

HSS on the Move says:

Hi Joann, thank you for reaching out. Please contact our Physician Referral Service at 877-606-1555 for further assistance.

Samantha schirmer says:

I have an appt there on Jan 8 th with Dr Ashany.. I hope to get a diagnosis and some answers to my Medical problems. Why is it so hard to get a diagnosis?

HSS on the Move says:

Hi Samantha, thank you for reaching out. Dr. Alana Levine, Rheumatologist, says: “Some medical problems can be extremely difficult to diagnose. Rheumatologists, in particular, diagnose and treat a variety of diseases, some of wich are extremely rare. Because they are so uncommon, it can be challenging for primary care or family doctors- or even rheumatologists- to diagnose them right away. In addition, the symptoms of rheumatic diseases can be vague, especially at the beginning of the illness. This can make it hard to figure out the cause of the symptoms. Dr. Ashanny is an excellent physician.” Let us know if you need further assistance.

Johnson @ Orthopedic Surgery India says:

Very informative Dr. Alana. Many types of rheumatic diseases are not easily seen at an early ages, but a rheumatologists are specially experienced to do the work needed to determine the root of swelling and pain. It’s essential to know the correct diagnosis early so that right treatment can start early because some disorders respond best to treatment in the early stages of the disease. So it”s always important to put an effort into getting the right doctor, but if a patient can”t find rheumatologist at all, looking for a primary care doctor who treats many RA patients may also be possible.

S.K.LIMAYE says:

My sister was diagnosed with Rheumatoid Arthritis (had positive RA factor and value in three digits).She had developed a skin deep ulser on her feet between ankle and knee.Even skin grafting operation failed.The ulcer was skin deep but spreading and some fluid oozed out.She eventually died.Was it due to Rheumatoid Arthritis ?

HSS on the Move says:

Hello, thank you for reaching out. Dr. Susan Goodman, Rheumatologist, says: “Rheumatoid Arthritis is a systemic disease, and rare patients with RA may develop skin ulcers due to vasculitis. Vasculitis can be a very serious condition in which the blood vessels become inflamed. Blood vessels provide nourishment and oxygen to all parts of the body, and inflammation may cause them to become blocked, leading to death of tissues fed by those blood vessels. This may lead to skin ulcers when the small blood vessels to the skin are affected, but internal organs may be similarly affected, leading to heart or kidney damage. Patients at risk for Rheumatoid Vasculitis typically have extremely high RA factor levels, although in the vast majority of patients, a high level only signifies worse joint disease, and may even occur in patients who do not have RA. Vasculitis is the most life threatening complication of RA. While many people think of RA as a joint-only disease like osteoarthritis, the entire body can be affected, and sadly, severe cases can be life threatening. It is certainly possible that your sister died of this rare form of RA.”

Sarah Carnahan says:

Do I need a referral from my primary care physican to be able to see a rheumatologist? I have been diagnosed with arthritis and fibromyalgia by my regular physician, but would I benefit from seeing a rheumatologist?

HSS on the Move says:

Hi Sarah, thank you for reaching out. To find out if you need a referral, it is best to check with your insurance provider and their guidelines. To learn more about referring to a rheumatologist, please visit http://www.hss.edu/rheumatology-referral.asp. If you wish to receive care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

Jeanette Kiesnoski says:

I have osteoarthritis in multiple joints and have had meniscus surgery twice in each knee, implant in right 4th finger, carpal tunnel surgery, trigger finger surgery, cervical C3-C5 implant and soon to have thumb surgery with another carpal tunnel surgery. My rheumatologist has nothing to offer because medication does not work for me nor has cortisone treatments. Any ideas?

HSS on the Move says:

Hi Jeanette, thank you for reaching out. Dr. Lisa Vasanth, Rheumatologist, says: “Current non-operative treatment for osteoarthritis aims to improve pain and function. Management generally includes a combination of approaches: low impact exercise, weight reduction if indicated, physical and occupational therapy, assistive devices such as canes or braces, pain management with analgesics (Tylenol or tramadol) or non-steroidal anti-inflammatory drugs (topical or oral), and injections with intra-articular glucocorticoids or hyaluronans. For those who do not respond or who are unable to take standard treatments, there are second line medications for pain management including serotonin-norepinephrine reuptake inhibitors like duloxetine and milnaciprin. There are also experimental biologic agents and intra-articular therapies for pain management, which are best discussed with your rheumatologist. To date, there are no licensed medications for osteoarthritis which inhibit structural disease progression. However, there are many prospective agents under investigation.” If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

larry robinson says:

I am just a regular person who suffers from arthritis/arthritic due to injuries & past surgeries. I have Local 1199 as my medical insurance carrier. I desperately need to locate a Rheumatologist who can assist me immediately with my daily medical problems.

Can someone point me in the right direction
I need help now.

Thank you.

HSS on the Move says:

Hi Larry, thank you for reaching out. Mavis Seehaus, Social Worker, says: “The best course of action would be to contact your 1199 insurance plan to find out rheumatologists that are in your network. You might also check to see if you have out-of-network benefits that would allow you to see a rheumatologist here at HSS, if you would like to.” If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

Diana Cardoza says:

Hi doctor,

I have been suffering from vasculitis from past 7 years. I am under Ayurvedic treatment, although it works very slow but effective. My size and frequency of the wounds have reduced since then but i still do get them on my ankle sometimes. I a lot of restrictions on the diet have helped me throughout. Doctor says there is no fixed cause for this and it should go on its own, I want to know more on this condition. Its has been told that its is because of autoimmune.

HSS on the Move says:

Hi Diana, thank you for reaching out. For more information on autoimmune diseases, please visit http://www.hss.edu/condition-list_autoimmune-diseases.asp. If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

Colleen says:

Hello, I am scheduled to see Dr. Levine. I am so scared…i don”t know what to expect, I have been sick for so long. I am terrified. Do you offer support services at HSS?

I think from what I see Dr. Levine is a compassionate doctor. I am praying she can help me.

HSS on the Move says:

Hi Colleen, thank you for reaching out. Emily Reiss, Rheumatology Social Worker, says: “Cultivating a relationship with a new doctor can be frightening. At HSS, Social Work Services are available through the Department of Social Work Programs. Social workers like myself meet with patients regarding concerns about the impact of illness and treatment options, provide emotional support and assist with accessing resources. There are also a number of disease-specific support and education programs available to meet the needs of our patients and their families through the Social Work Programs Department. For more information, you can go to our website: http://www.hss.edu/social-work-programs.asp.”

Laura G. says:

Hi, doctor!
I was diagnosed with Hashimoto’s about a year ago. Recently i started developing pain in my right elbow and the MRI proved I had lateral epicondylitis and exterior tendonosis. I do use my right arm extensively at work, but now I have the same symptoms on my left arm around the same area as on the right. I was wondering if Im developing one of those rheumatoid diseases in connection with my thyroid condition? Will you be able to diagnose me?
Thank you in advance!

HSS on the Move says:

Hi Laura, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It is not unusual for people with Hashimoto’s thyroiditis to develop other symptoms of arthritis, sometimes indicating a second illness and sometimes just due to changing thyroid function. However, the MRI report that you give suggests overuse. If you don’t use your left arm as extensively as you use your right, then there is a reason to wonder whether the MRI was read correctly. It is probably worth reviewing that with your doctor, since I would not expect both the right and the left arm to be involved with overuse.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Ken W says:

Dr. Alana B. Levine is a specialist with Sjogren”s syndrome. I am a 62 year old male in good health but dry eyes (takes restasis drops) dry mouth, and has joint pain.. I understand 9 out of 10 people with Sjogren”s are women. I might possibly have the condition. Does Dr. Levine see male patients?

HSS on the Move says:

Hi Ken, thank you for reaching out. Yes, Dr. Levine does see male patients. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Siera Rogers says:

Hello Dr., While pegnant (over two years ago) I was diagnosed with preeclampsia… Further investigation and testing from the doctors lead to a diagnosis of ITP, antiphospholipid antibody syndrome (APS) and I was suspected of having lupus (due to positive ANA, lupus anticoagulant and anticardiolipin antibodies etc). Now that I have better insurance I”m going to a rheumatologist locally with my first appointment next month, but I”m not sure what to ask for my first visit. I am having awful joint pain and swelling in my hands (including wrists and fingers), feet, right hip and shoulders (daily), with chronic migraines happening every other day. Are there specific questions I should be asking at this appointment to ensure the correct diagnosis? Also, are there specific blood tests I should be requesting? Also, I have kept a detailed diary of all my symptoms for the past 6 months.

HSS on the Move says:

Hi Siera, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “You should tell the doctor all you have just asked and ask for these tests as the doctor should know this already. Many can be repeated since it has been two years, including CBC, chemistry profile, urinalysis, ANA, Anti-DNA, Anti-Smith/RNP, Anti-Ro/SSA and Anti-La/SSB, anticardiolipin, lupus anticoagulant, and ESR. Good luck to you.” It is best for you to seek consultation with a physician to determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Jennifer hawk says:

My daughter is 13 years old and has been a softball players since 5 years old. She is already being scouted by colleges but the past 7 months she has had severe back pain all over and hasn”t been able to play? We”ve had an MRI and bloodwork and nobody can find anything wrong? It”s very frustrating and I hate seeing her in this pain. It gets hurting so bad it takes her breath away. Do you think she would benefit from seeing a rheumatologist? I just don”t know what else to do and there has to be something wrong for her to be in such pain for so long!! Please help and advise.
Thank you.

HSS on the Move says:

Hi Jennifer, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It is certainly unusual for a 13 year old to have severe back pain. Yes, i do think that it would be useful for her to see a rheumatologist.” If you wish to seek consultation for your daughter at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Renea A. says:

Thank you for all the comments on here. I have been having trouble with my wrists and ankles for some time and I also suffer from Panic attacks and Generalized Anxiety Disorder so I try to ignore all my issues so I don”t look like a hypochondriac but I can put it off any longer. I am at the point I can hardly use a manual can opener or get my daughter out of her car seat. I guess I will be on the search for a rheumatologist. Thanks again.

HSS on the Move says:

Hi Renea, thank you for reaching out. We’re sorry to hear about your situation. If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

V.H.Ashley says:

Hi, I have Raynauds and my orthopedic doctor won’t do surgery on the base of my right thumb until I get a clearance from a rheumatologist, why is that?

HSS on the Move says:

Hi, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “I can’t think of a good reason, except maybe the orthopedist wants to be sure there isn’t a systemic rheumatic illness present that would complicate surgery. However, there aren’t many reasons related to systemic rheumatic illnesses that would make a difference at the base of the thumb.”

Jason says:

I have been having symptoms of soreness in my hands , fingers and just recently started in my feet , toes and ankles. By the end of the day I can barely walk they hurt so bad. When I’m at home they also hurt without my shoes on. Does this sound like it might me rheumatoid arthritis? My family Dr has put a referral in for a rheumatologist. RA run both on my mom and dad’s side of the family. I started get symptoms of soreness in my hands back in 2013 my Dr tested me for the rheumatoid factor but it came back negative. The soreness came back in September of 2014 and again when I went to my doctor a second time about the soreness in my hands he tested me a second time for the rheumatoid factor and again it came back negative he also did x-rays the second time and they showed nothing. When the symptoms came back a third in I started feeling it not just in my hands but in my feet on the top of them and on the bottom as well and through my toes. I wake up with the soreness every morning and it seems to stay there through out the duration of each day. My daily activities my it worse . My question is could it be that rheumatoid arthritis is starting to form or is it another for of arthritis? Also should I go on and see a rheumatologist about this too?

HSS on the Move says:

Hi Jason, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It does sound as if you are developing some type of arthritis. It could be rheumatoid- you don’t need to have a positive blood test to make this diagnosis- or something else. A rheumatolgoist should be able to sort this out.” If you wish to seek care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Thinh says:

Hi, I””ve been having lower back pain for almost a year now. I have been treated by physio therapists, osteopath, chiropractor, myotherapist and acupuncturist unsuccessfully. It started out as a tingling pain or burning sensation at the lower back area. I could walk, stand, bend backward or forward no problems, no pain down the legs. Mainly to do with sitting, I can””t sit longer than 15 mins without the feeling that the pain is coming. Some nights I can””t lie on my back without pain, pillows below the knees doesn””t help as the burning sensation feeling is there when a friction with a mattress occurs. If I apply ice, then it settles down however next morning it aches a lot. It eases a bit when I sit slump like a C shape.

I am an active person, I don””t sit longer than 15 or 20 mins at a time, I walk a lot, I do social swimming a few times a week.

X-Rays and RMI came back with nothing. Blood tests for HLA, or other type of arthritis come back with negative, no inflammation in blood was found.

Is there anything you can please advise ?

Thank you so much.
Regards
Thinh

HSS on the Move says:

Hi Thinh, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It’s not really a lupus problem that you are talking about, but it is something that a rheumatologist (or an orthopedist) can help you with. A thoughtful rheumatologist or orthopedist may be able to review all of your x-rays and MRIs, and examine you, to suggest a solution.” If you wish to seek consultation at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Michelle says:

I have been diagnosed with very bad arthritis in my left knee. Had a torn meniscus years ago and the pain is awful now. It travels from the knee to my toes and the back of my knee and leg. Is it time to see a Rheumatoligist? There are days I can only walk a few feet and thats it. Can’t bend the leg or anything. Its terrible. Any information is appreciated. Thank you!

HSS on the Move says:

Hi Michelle, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It’s not actually a lupus problem that you are talking about, but it is something that a rheumatologist (or an orthopedist) can help you with, so, yes, it is time.” If you wish to seek consultation at Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Clarissa Aboubaker says:

I have a major concern. I have seen two podiatrist due to pain and swelling in my left ankle,pain on top of foot and bottom of foot.I work 12 hours at a hospital after 5hours into my shift the pain is hurting so bad.I have had compound pain creams that doesnt work. I wear ankle brace that does not help. Tramadol is not touching my pain of 10 plus would it be better for me to see a Rheumatologist. I was told that I have arthritis and neuropathy

HSS on the Move says:

Hi Clarissa, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Yes, a rheumatologist should be able to help you. If you have arthritis and neuropathy it may be that an orthopedist and/or a neurologist could help as well.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Christi says:

Hi I have had on and off trouble with my hand feet hips and knees hurting and swelling. Since 09 I had one positive test for lupus in 09 then the rumatoligist never contacted me back. A couple mounts ago started haveing my hair fall out in a wod straight from the root, I have red rash on my face. and feeling extremely tired a lot. My family dr did more blood work and it came back positive for ana,dsdna,ssa,and ssb antibodies. Does this mean I have lupus? Will the rumatoligist do their own blood work? Also why did my dr think I had it back in 09 but rumy didn””””t?

HSS on the Move says:

Hi Christi, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “If all those antibodies are positive, yes, it is the case that you have lupus. Whether your rheumatologist will repeat the laboratory tests will depend on how much he/she trusts the laboratory tests that you already have. If the tests are recent and from a laboratory that can be trusted, they don’t need to be repeated to make treatment decisions.”

kimmey says:

Hi I have a level L5 herniated disc and C3 cervical disc my severe joint pain in my legs and my pain management is not helping any suggestions?

HSS on the Move says:

Hi Kimmey, thank you for reaching out. Dr. Darren Lebl, Orthopedic Spine Surgeon, says: “While many disc herniations can improve with time, this is not always the case. In particular, if a nerve is being severely compromised there is risk of permanent neurological deficit. A high quality MRI scan should be reviewed by a spine specialist if the pain in the legs and arms have not been improving. Depending on when the initial MRI was performed, a more recent interval MRI scan may be worthwhile to evaluate any potential reabsorption of the disc herniation and potential consideration for surgical intervention. If any dense areas of numbness, weakness, bowel or bladder incontinence, then the disc herniation should be evaluated by a spinal surgeon right away.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Christina says:

I just saw my General Practioner and he said I have arthritis in the spine and hip, but he does not believe I should see a rheumatologist. Instead he is sending me to a pain management doctor. I am a female, 43 years old and have had chronic back pain for over 20 years. It is progressively getting worse. Some mornings I can barely walk due to the pain and stiffness. I am just wondering if a rheumatologist will be more effective at treating my back and hip pain?

HSS on the Move says:

Hi Christina, thank you for reaching out. Dr. Michael Lockshin,Rheumatologist,says: “You are very young to have such problems and, of course, arthritis is something Rheumatologist deal with. A Rheumatologist may end up sending you for pain management but might also find something that can be dealt with in a different way, so, yes, I recommend getting a rheumatology opinion.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Pua Fabella says:

My son was diagnosed with dyshidrotic eczema by a dermatologist. He suggested my son see a rheumatologist. Is that something a rheumatologistn treats. I have researched it but can””t seem to find the relationship. I would appreciate your assistance. Thank you.

HSS on the Move says:

Hi Pua, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Eczema (all types) is usually handled by a dermatologist. It has nothing to do with rheumatology, unless there is a question about the diagnosis, or the name is wrong. It would be best to consult with your son’s dermatologist for clarification.”

karen says:

hello, i am not sure if I should see a neurologist or rheumatologist. my symptoms include joint pain and achiness in the hands, wrists, arms, legs, feet, ankles. for years I have had neck pain and now even the tailbone is sometimes uncomfortable. numbness and tingling in both hands but usually occurs while sleeping although I have one fingertip that is slightly numb right now. reoccurring vibration in feet, almost like a very mild electrical charge. this feeling comes and goes. it may be noticeable for a month or so, and then may not happen for months. i did have an MRI about 4 years ago to rule out MS and all was well but a microadenoma was found on the pituitary, so i return for follow up MRI””s (of course that””s just concentrating on that area of the brain)

my primary, who is brand new to me, gave me a referrel to see a neurologist for parathesia of the hand. so maybe there is some carpal tunnel, but I feel that she just overlooked all the other info I was giving her upon my regular checkup (1st time with her).

any input would be appreciated!

HSS on the Move says:

Hi Karen, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Those types of nerve problems could be caused by arthritis or they could occur independently. Since you mention joint pains and carpal tunnel, a rheumatologist is more likely to look at all of the areas. The microadenoma is probably unrelated. It is a fairly common and usually not too important abnormality. However, if it is secreting hormones, especially growth hormones, it could cause your problems. The endocrinologist or neurologist will have done tests about the hormones, I assume.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

jim souza says:

recently i have been having burning in my feet. it will appear in my shins and maybe later above my knees. my feet get real cold when burning goes awy then repeats. also have tinging in feet. same is true in my hands. can a rheumatologist help? my neurologist is referring me to one because of elevated CRT levels.

HSS on the Move says:

Hi Jim, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It depends on what else is going on. For example, how old you are and if you have any other nerve problems. High CRP levels mean inflammation, so that is probably the reason for the referral. It sounds like nerve injury is the concern (peripheral neuropathy), which can be caused by some rheumatic diseases. More often, however, it is due to something else.” If you wish to receive a consultation at Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Doug Hosie says:

Hello, I””ve been diagnosed as having Sarcoidosis in my lungs and in the past six months or so, I””ve noticed white circular spots on my forearms and upper chest area. Is it possible that these spots are a result of the Sarcoidosis and if so, is there any way they can be removed as not to be so noticeable? Thank you

HSS on the Move says:

Hi Doug, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Hard to tell without actually seeing the spots. Sarcoidosis can affect the skin. When it does, it causes soft little lumps (less than half an inch/1 centimeter), sort of like warts. Another reason for white circular spots (a few inches/5 centimeters) across would be vitiligo, which is a different autoimmune disease, or a fungus infection. Dark-skinned people sometimes develop very small light spots (1/8 inch, 1-2 millimeters), which mean very little. A dermatologist who sees what you are talking about could tell you more.”

Mary says:

What is the difference between rheumatology and orthopedics, and rheumatologists and orthopedists? Which would be more appropriate to see about osteoarthritis of the knee and knee replacement options? Thank you.

HSS on the Move says:

Hi Mary, thank you for reaching out. The difference between rheumatology and orthopedics is that rheumatology focuses on the study of rheumatic disease, arthritis, and other disorders of the joints, muscles, and ligaments while orthopedics focuses on the study of the musculoskeletal system and the correction of deformities of bones or muscles. A rheumatologist is a board-certified internist or pediatrician who is qualified by additional training and experience in the study of rheumatology. An orthopedist is a medical doctor who specializes in diagnosing and treating musculoskeletal conditions. In your case, it would be more appropriate to see an orthopedist about osteoarthritis of the knee and knee replacement options. If you wish to receive any care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Mary says:

Thank you for your reply.
I am considering going for hyaluronic acid injections to the knees before going ahead with knee replacements. From what I have heard, both orthopedists and rheumatologists can do this procedure. Is this correct and is one better-suited to do this than the other? Thank you.

Ted says:

Hello I am 26 years old and I joined Crossfit 14 days before being admitted to the hospital for Rhabdomyolysis. At my 7th Crossfit class we did ring rows, rowing machine, and push-ups as many as we could do during 2 minute intervals 3 times. I did 101 ring rows, 75 push-ups, and burned 55 calories on a rowing machine. I performed these exercises until failure multiple times. After class I had usual soreness. 2 days after I noticed swelling in my biceps just above the elbow. We went to the ER and asked to get CK levels tested and they came back at 32,000. I was admitted to the hospital and put on IV fluids for 3.5 days. My CK was at 1,000 5 days after I was admitted with a CK level of 32,000. I was tested 13 days after original admission and my CK level was normal 94. I have never had this happen before, I was new to Crossfit , I was in moderate not great not terrible shape before Crossfit. Should I see a rheumatologist because Rhabdomyolysis is so rare?

HSS on the Move says:

Hi Ted, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Although it is possible that it was the exercise alone, there are some genetic causes of rhabdomyolysis, which could be important to know about. You should see someone who is an expert in muscle disease. It could be a rheumatologist or a neurologist- both see this type of illness.” If you wish to receive care at Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 for further assistance.

jeff says:

I have been dealing with osteoarthritis for years, I also have celiac disease, usually it gets easier in the summer but it seems to get worse every year I have tried just about everything in the past I””ve had numerous blood test done to no avail. I never know where the pain is going to be, I will be talking to my Dr today hopefully about seeing a rheumatologist any advice would be great.

HSS on the Move says:

Hi Jeff, thank you for reaching out. For advise on speaking to your physician, check out our blog article http://hss.edu/onthemove/tips-for-talking-with-your-doctor/#.Vd3HoflVhBc. We wish you the best! Take Care!

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