If you’ve been experiencing persistent joint or muscle pain, stiffness and/or inflammation that you can’t explain (e.g. from a fall or strenuous physical activity), you should discuss your symptoms with your general practitioner (GP).
Many conditions can cause these symptoms, so to work out what’s causing your symptoms, your GP will:
- Take your medical history. They’ll ask you about your symptoms, when they started, how they affect you, your family medical history and other health issues you may have.
- Do a physical examination. They’ll look for redness and swelling in and around the joint and test your joint’s range of movement. They may also look for rashes, check your eyes and throat, and take your temperature.
- Order scans and other tests. Depending on the condition your GP thinks you might have, they may send you for tests to check for levels of inflammation in your blood or specific genetic markers. You may also have scans such as x-rays, ultrasound or CT (computed tomography) to get a clearer picture of what’s happening inside your body.
When your GP has gathered all of this information, they may refer you to a rheumatologist.
Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system. You need a referral from your GP to see a rheumatologist, whether they’re in private practice or a public hospital outpatient clinic.
Your GP may refer you to a rheumatologist if:
- they think you have, or they’ve diagnosed you with, an inflammatory type of arthritis such as rheumatoid arthritis or ankylosing spondylitis, so that treatment can be started as soon as possible
- your symptoms improve with treatment but come back when you stop taking medicine
- your symptoms don’t respond to treatment or get worse over time
- you develop unexpected complications, such as a fever, rash, or fatigue
- you have unusual test results.
Preparing for your first consultation
When you make an appointment to see a rheumatologist, you should ask them some questions so that you’re prepared. This may include:
- What do I need to bring with me?
- How much will my out-of-pocket expenses be?
- How long will my appointment be?
- Is there parking available, or accessible public transport?
Armed with this information, you can be proactive and prepare for your consultation.
It can be helpful to make notes about your symptoms – when you first noticed they appeared, how they affect you day-to-day – as well as other health conditions you have, medicines or supplements you take regularly and information about your family medical history.
It’s also helpful to write down questions you want to ask your rheumatologist. Put them in order of the most important first, in case you don’t get through your entire list.
Your consultation
Seeing a specialist can sometimes be overwhelming, especially if you’re feeling unwell or anxious. There can also be a lot of information to absorb. That’s why it can be helpful to bring a family member or a friend to your appointment. They can provide emotional support, help you ask questions or write down any important information. They can also be a second set of ears to hear what the specialist says and help you recall this information later. It can be hard to remember everything, especially when you’re feeling anxious.
Wear comfortable clothing that can be easily adjusted or removed if necessary, so that the rheumatologist can examine you.
And don’t forget your referral, x-rays, scans and other test results, your list of questions and any other bits and pieces you were asked to bring!
Your first consultation with your rheumatologist will be more thorough than your consultation with your GP. They’ll:
- review your medical history
- ask lots of questions about your symptoms, such as when you’re most stiff or sore, and how long you’ve had pain and symptoms
- do a comprehensive examination of your joints, including counting the number of tender and swollen joints
- refer you for further blood tests and imaging if required.
It’s important to know that there are many different types of musculoskeletal conditions, and many have similar symptoms. So it can take time to get a diagnosis. Your rheumatologist may provide you with a prescription for medicines and suggest some self-care options that you can do while you wait for your diagnosis.
Follow-up consultations
Once your diagnosis has been made, your rheumatologist will provide you with information about your condition and a treatment plan.
Your treatment plan will fit your specific symptoms, needs and preferences. However, it will usually involve a combination of:
Depending on your diagnosis, you may need regular consultations with your rheumatologist.
How often they occur will depend on your condition, how well it’s responding to treatment and the medicines you’re taking, as some specialised medicines can only be prescribed by a rheumatologist. Some people see a rheumatologist regularly, while others are mainly treated by their GP, with the rheumatologist on hand for specialist advice. Some consultations with a rheumatologist may be done via telehealth.
Follow-up consultations are generally shorter than your initial one. Your rheumatologist will talk with you about how you’ve been doing since you began treatment. They’ll assess how well you’re responding to treatment and if you need to change your medicines or add additional ones. They’ll also do a physical exam and order any further blood tests or imaging if required.
Your rheumatologist will also talk with you about your self-care and other things you can do to manage your condition.
It’s important to take an active role in these consultations. Ask questions, and if you don’t understand the answers, ask them to explain further or for more information. Talk with your rheumatologist about your goals for treatment – they may be things like reducing pain and fatigue, but also more personal goals such as getting back to playing golf regularly or planning an overseas trip. Together you can ensure your treatment plan supports your goals.
Ongoing care
The aim of treatment for musculoskeletal conditions is low or no disease activity. This is called remission. It doesn’t mean your condition has been cured, but your treatments keep it under control.
With the significant advancements we’ve had in medicines in the past few decades and targeted treatments for many types of musculoskeletal conditions, achieving remission can be a real possibility.
If you achieve remission, your rheumatologist may reduce the dosage and/or frequency of the medicines you’re taking. They’ll monitor you to see how you’re doing and make changes as required. And you won’t need to see them as often.
If you haven’t achieved remission, the aim will be to control your condition and its effects on your body and life as much as possible. This will determine how often you need to see your rheumatologist in the future.
Costs
The cost to see a rheumatologist varies. Part of the cost is subsidised by Medicare, but there is usually a gap payment that you’ll need to make. When making an appointment, ask about out-of-pocket costs.
If you have a Medicare card, you may be able to attend a rheumatology clinic at a public hospital if you cannot afford out-of-pocket expenses to see a rheumatologist privately. Talk with your GP about your options.
Contact our free national Help Line
Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.
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First written and published by Lisa Bywaters in May, 2022.
