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: Featured, 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.

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.

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