A rheumatologist manages patients who are suffering from various autoimmune and inflammatory rheumatic disorders.  This group of conditions could affect almost any organ system of the body such as the muscles, joints, bones etc. Most conditions which cause joint pain, swelling or stiffness fall into this category of disorders. The rheumatologist would therefore try to identify a specific cause for the patient’s symptoms and treat the patient accordingly.

Usually, patients are referred to a rheumatologist by a General Practitioner/Family Doctor or by another Specialist. This referral would have been thought to be necessary following investigations for various complaints. The results of the investigations may have suggested the possibility of an autoimmune rheumatic disorder.

Some patients may have been advised by friends, family, pharmacy personnel, etc. about the benefits of a rheumatology review for further management of their joint pain. In our setting, a patient may therefore choose to schedule a visit with a Rheumatologist on their own accord, as opposed to visiting their General Practitioner/Family Doctor.

The visit to the rheumatologist would involve a detailed history of the patient’s complaints, which includes the story of the patient’s symptoms and all that has happened leading up to the visit.  It is therefore very important that when visiting a Rheumatologist, patients are prepared to give a detailed account of the sequence of events which has led to the visit.

In order for the Rheumatologist to have a proper idea of what has been happening to the patient, it is important that the patient relates the details of teach symptom and treatment to the Rheumatologist. It might even be helpful to take note of key points of the history prior to the visit with the Rheumatologist. Questions about other medical conditions, surgical procedures, medications and family history would also be asked. Some questions may seem irrelevant, but they are very important when trying to make a final diagnosis.

After the history is taken an examination of the body would be performed. This examination is usually focused on the areas of complaints; however, the Rheumatologist may choose to do a more generalized examination if thought to be appropriate.

All previous investigations will be reviewed. It is therefore very important to take all blood, x-ray, ultrasound, and other reports to the visit. These previous investigations should be placed in an order which would facilitate easy review. 

It is very likely that additional investigations would be requested by the rheumatologist. These additional investigations would be aimed at finding abnormalities which would support a specific diagnosis.

After this initial visit, it is likely that the rheumatologist would offer some medications that would help with the patient’s symptoms. These medications may include painkillers or steroids. The medications are usually given to last the period when the patient is scheduled to return with the results of all investigations that were requested. It is therefore important that the patients keep follow up appointments as scheduled.

The patient may also be advised about dietary and lifestyle changes that would be beneficial in the treatment of their condition. Some of this advice may have benefits applicable to other diseases such as diabetes, hypertension etc.

If there is a strong suspicion of a specific diagnosis, the rheumatologist may begin a consultation about preparation for long-term treatment. Some of the investigations requested may be in preparation for long-term treatment, such as blood counts, kidney function, liver function, chest x-ray, etc.

Recommendations may also be made for the patient to begin updating their vaccinations as this forms an important part of preparation for long-term treatment.

Dr. Haramnauth Dyaanand
Rheumatologist