Besides joint injections with a single type of medication(i.e. cortisone or maybe 1 or others like infliximab)? And fluid drainage of a joint? What happens to that patient? Does he return in a month for the same drainage and/or cortisone shot? And if he gets something like a kidney problem then you send him to a kidney specialist? Are there any difficult clinical exam findings? I mean autoimmune diseases seem interesting based on ms2 clinical vignettes. But also based on those clinical vignettes it seems that the patient will be referred to a rheumatologist by the time his diagnosis has already been made? And then what would he get except for the same type of meds for the rest of his life? Thanx.
What do rheumatologists do?
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Also a question about "undiagnosed joint pain" and joint injections/ultrasound. As I understand both PMR, Family Medicine with Sports and Rheumatology do those? So how would they differ in terms of their workup/diagnosis/limits of procedure?
And in our path textbook when it discusses any autoimmune disease they often include "biopsies". For example skin biopsy for psoriatic rheumatoid arthritis. Or Gi mucosal biopsies. Whats the point of doing all those if antibodies in the blood are usually more specific? And would biopsies be referred to specialists such as dermatology=skin biopsy or GI=gi biopsy?
And in our path textbook when it discusses any autoimmune disease they often include "biopsies". For example skin biopsy for psoriatic rheumatoid arthritis. Or Gi mucosal biopsies. Whats the point of doing all those if antibodies in the blood are usually more specific? And would biopsies be referred to specialists such as dermatology=skin biopsy or GI=gi biopsy?
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I can move it for you.
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I've seen a rheumatologist as a patient, and much of the time I worked with her was spent coming to a proper diagnosis - not a simple matter in my case, given that my results on most of the tests run just told us what it wasn't - and then much of the rest was working out an appropriate treatment plan which required some trial and error.
Antibody tests also don't show everything. I've been told many patients with oligoarticular JRA, for example, have a negative rheumatoid factor test. Sometimes, a biopsy may actually be more informative.
Antibody tests also don't show everything. I've been told many patients with oligoarticular JRA, for example, have a negative rheumatoid factor test. Sometimes, a biopsy may actually be more informative.
In pathology text it says so also about JRA. And that in 80% or so it resolves on its own. So how did you decide to see a rheumatologist? And what insightful questions or physical exam tests did he do? Or lab tests? did he do to arrive at a diagnosis?
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well I just recently saw a rheumatologist and he was able to diagnose my ankylosing spondilitis in 2 visits following blood work, mris, and a bone scan. After 9 years of hip/lower back pain he was the first doctor to finally call it something other than growing pains. so i say they save lives just as well as the next doc
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I was dealing with some pretty severe pain in my wrist (as in, wake me up crying at 3 AM pain). I saw an ortho guy who said it was carpal tunnel, but the brace he put me in did nothing. My mom was talking with our neighbor, a now retired OB/GYN who's a good friend, about what was going on and he pretty much said carpal tunnel doesn't produce the visible swelling I had and I should probably see a rheumatologist.
I can't remember the full battery of tests I had - it was years ago - but they included ones for Lyme, rheumatoid factor, and a joint biopsy. Pretty much exhausted everything she and a couple of her colleagues at my state's top medical center cold think of. She looked at the x-rays the ortho guy took and was pretty ticked - the arthritic damage was obvious, and he'd missed it. Would my issue have resolved on its own eventually? Maybe. But I'd have been in a lot more pain, and done more damage to my joint without the meds she put me on.
I can't remember the full battery of tests I had - it was years ago - but they included ones for Lyme, rheumatoid factor, and a joint biopsy. Pretty much exhausted everything she and a couple of her colleagues at my state's top medical center cold think of. She looked at the x-rays the ortho guy took and was pretty ticked - the arthritic damage was obvious, and he'd missed it. Would my issue have resolved on its own eventually? Maybe. But I'd have been in a lot more pain, and done more damage to my joint without the meds she put me on.
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Rheum is an awesome specialty. They do a fair number of procedures and practice what is in my opinion one of the toughest diagnostic specialties in medicine. I've never, ever seen a patient present the same way twice with a particular rheumatologic condition (especially lupus).
They frequently get referrals by PMDs for weird, unexplainable symptoms which involve joint pain (since that's often how lupus presents) and they also get simple things like the person with refractory RA. They do a lot of joint injections and drainages, much like PM&R does but they deal with the more severe medical diseases like RA, lupus, JIA/Still's, etc. They follow these patients for a long time, medically managing their diseases. They will sometimes do arthrocenteses (so will PM&R and orthopods and sports medicine docs, in all fairness) as well as joint injections of steroids, euflexxa, etc.
In conclusion, rheum is the bomb.
They're very good at what they do. Here, we have a few older rheumatologists, so they rely heavily on history and physical and use blood work and imaging as confirmatory tests (how it's supposed to be done!!). They're very good problem solvers and can sniff out an inflammatory process from across the room. They can also identify whether something is autoimmune or not, which can extremely helpful if you're trying to work up a patient for fatigue, weight loss, and pain.
Usually, they stick to the clinic, but they also see inpatients as consults. It's a fairly diverse field, and they have a broad knowledge of IM and apply it on a daily basis.
Usually, they stick to the clinic, but they also see inpatients as consults. It's a fairly diverse field, and they have a broad knowledge of IM and apply it on a daily basis.
