Health Essentials from Cleveland Clinic

By: Howard Smith, MD

In my many years as a rheumatologist, I’ve seen patients with a variety of symptoms, including aches and pains. Arthritis may be a symptom of a number of different connective tissue diseases; there are more than 100 different types of arthritis. My job is to identify which type of arthritis the patient has, and then, to initiate appropriate treatment.

As a rheumatologist, I perform a thorough examination. It helps me make a diagnosis so that I may begin to treat you as soon as possible – especially because many rheumatologic conditions become more difficult to treat over time and respond best to treatment in the early stages. Because these diseases may change or evolve, your rheumatologist may need to see you more than once to make a definite diagnosis.

Remember that a first appointment can be an hour or longer, and much of this time is spent talking about your symptoms.

The first visit will include a physical exam in which I search for joint swelling or nodules that may indicate inflammation. Lab tests, such as X-rays and blood work, may also supply pieces of the puzzle to assist me in arriving at your diagnosis.

To help you make the most of a first appointment, here are three simple tips:

Tip #1: Know your symptoms.

The more you have studied your own symptoms, the more you can help your doctor diagnose your condition. Consider keeping notes in advance of your appointment to bring along.

Ideally, your notes will include:

1. Description of pain (dull, stabbing, throbbing?)
2. Where in the body you feel pain (muscles or joints?)
3. Time of day if applicable or days when pain was better or worse (when does the pain start and how does it progress? Dates and times the pain started and stopped?)
4. Overall length of time you’ve had symptoms
5. Any other symptoms besides joint, muscle or bone pain that seem connected
6. Your ideas about what might be causing the problem (does any particular physical activity, stress or food worsen your symptoms?)

Tip #2 Ask questions.

During your appointment, it can be easy to forget some of your questions or to ask those that are not as important to you as others you meant to ask.

One of the best ways I’ve noticed to handle this is to write down your questions before your appointment and put them in order of priority. Of course, if you forget, you can always call the office later, but it is best to have your important questions answered in person.

Common questions I hear include:

• When I’m in pain, should I use the joint/muscle or rest it?
• How do I treat the pain (ice? heat? pain relievers?)
• I wake up aching. Should I get a softer mattress? Are there other things I can do to wake up feeling better?
• Should I change my diet (or avoid hot or spicy foods?)
• Are there vitamins or supplements I could take to help the inflammation?
• If I need special medication, will I have to take these for the rest of my life or is it possible to get better?
• Is it okay to become pregnant with this condition? Are there medications that are safe to take during pregnancy?

Tip #3: Be prepared to really listen.

It can be overwhelming when a doctor is offering advice about a new diagnosis. I notice that when patients bring a notebook or journal, they seem to better capture our conversation. If you bring notes about your symptoms, you can use that same notebook to take notes about what your doctor advises. You can also bring a friend or relative to your appointment to help you remember what your doctor explained and to be your advocate.

Following these tips can help you make the most of that first important appointment with your rheumatologist.