Doctor, My Joints Hurt!
You may have never heard of a rheumatologist until your referral. Rheumatology is a specialised field of medicine that includes the diagnosis and management of arthritis, autoimmune diseases, musculoskeletal pain and osteoporosis. Such conditions often begin with painful joints, but they also may affect many other organs such as the skin, eyes, blood, heart, lungs, kidneys, brain and the gastrointestinal tract.
A rheumatologist is specially trained to spot clues in the medical history and physical examination. Prompt diagnosis using the appropriate tests and timely tailored treatment improves your well-being and long-term outcome.
Joints form the connections between bones. They provide support and help you move. Many different conditions can lead to painful joints, these can be due to wear and tear of the cartilage like osteoarthritis and spondylosis, autoimmune disease such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, metabolic disorders like gout and pain arising from around the joint such as tendinitis and bursitis.
Listen to the Patient
My mentor Prof Graham Hughes always reminded me to listen to the patient. A recent patient I met highlighted this. She had been having joint pains for many years, had gone to many doctors and underwent several surgeries to relieve her swelling and pain. Finally, an orthopaedic colleague listened. She had inflamed joints that now affected her arms as well. I was asked to see her and by then, she had developed arthritis of her elbow, which affected her function. She had rheumatoid arthritis. The diagnosis was long overdue. Fortunately, she responded extremely well to medication and has gone back to having a life-free of pain.
How can you get involved?
Go back as far as you can: Create a timeline. It helps to recall when the first symptom started and how they have changed over time. Don't leave out the details.
Gather family history: Find out about the health of your grandparents, parents, siblings and even extended family. This is because autoimmunity tends to run in families. I often have patients who are diagnosed with lupus that have family members with thyroid problems for example.
Give feedback: Communication goes a long way in your path to recovery. All your concerns, fears, perceptions should be discussed. This helps in the partnership to restoring your health.
Dr Sheila Vasoo
MBBS, MRCP (UK), FRCP (Edinburgh), FAMS (Rheumatology)
Senior Consultant Physician & Rheumatologist