The earlier you start your search and schedule your first appointment, the better, says Ethan T. Craig MD, MHS, assistant professor of clinical medicine at the University of Pennsylvania division of rheumatology and a rheumatologist at Corporal Michael J. Crescenz VA Medical Center in Philadelphia. “In general, if a patient with psoriasis is experiencing chronic joint, tendon, or back pain that is not well-explained by injuries, overuse, or osteoarthritis, this would be a good reason for a rheumatology evaluation,” says Dr. Craig. Having a rheumatologist on board early may help to tailor treatments for both the skin and joint disease, he says. “Early interventions may prevent later problems such as erosive changes or damage to the joints from longstanding inflammation, which may not be reversible once they occur,” he says.
The Rheumatologist’s Role on Your Healthcare Team
A rheumatologist is an important member of the healthcare team for anyone with inflammatory disease, including psoriatic arthritis, says Craig. Psoriatic arthritis can affect the skin, joints, entheses (the connective tissue between tendons and bones), and spine, he says. Your rheumatologist will oversee your psoriatic arthritis management and treatment, which includes checking blood work and radiographs, says Ana-Maria Orbai, MD, assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore. “Your rheumatologist may make recommendations to your primary care doctor and other specialists about other health conditions that may occur at the same time as your psoriatic arthritis, such as heart disease, diabetes, liver disease, obesity, inflammatory bowel disease, or inflammatory eye disease, says Dr. Orbai. These questions will help in diagnosing and understanding the extent and impact of your disease, says Orbai. Typical questions could include:
Do you have a family history of psoriasis or psoriatic arthritis?Do you have a family history of autoimmune diseases, immunodeficiency or cancer?Do you have back pain or stiffness?Do you have joint pain or stiffness?Which joints are affected?What triggers a flare for you?What makes your psoriatic arthritis better?Has psoriatic arthritis impacted your function and lifestyle?
In addition to being prepared to answer questions, you’ll want to bring along some information as well, says Craig.
Results from other evaluations you have had. That includes labs results, prior X-rays or imaging studies (including the discs with the actual images if at all possible), initial consult notes and most recent progress notes from any other physicians you are seeing.A list of your current and past physicians and their specialties.A full list of your current medications, including over-the-counter medications and supplements.
What to Expect on Your First Visit
The diagnosis of psoriatic arthritis is largely a clinical one — there are no lab or imaging findings that necessarily make the diagnosis for us, says Craig. In addition to answering many questions, you will usually undergo a detailed joint exam, with particular focus on the areas that you have mentioned are symptomatic, he says. “What we are generally looking for in psoriatic arthritis is swelling or tenderness of the joints or the areas where tendons insert into bone, called the enthesis,” says Craig. “We will usually want to do a thorough skin exam, so you may be asked to put on a gown for this,” he adds. You shouldn’t necessarily expect a solid diagnosis at your first visit, which is common in rheumatology, says Craig. “This is for any number of reasons: Some treatments may interfere with our interpretation of findings, we may need further testing or imaging, or possibly the symptoms or findings are not specific enough to make a conclusion,” he says. In these cases, your rheumatologist will collect more information, or follow you closely and observe for changes in your symptoms and test results over time, says Craig. “It is usually better to have an uncertain picture than to be treated for an incorrect diagnosis,” he adds.
How to Choose the Right Rheumatologist
Your relationship with your rheumatologist doesn’t end after your initial diagnosis. Psoriatic arthritis is typically a lifelong disease, which means your rheumatologist is someone you will likely be developing a longstanding relationship with, says Craig. “While it is not easy to assess in advance, it is important that you have a rheumatologist you trust and have a good rapport with,” he says. Here are some qualities to look for when choosing a rheumatologist: They make time for you. “Get a doctor who can pay attention to you, not just the disease,” says Deeanne, who has psoriatic arthritis, as shared on Tippi PsA.That means your rheumatologist shouldn’t rush you out of your appointment. You want to find a rheumatologist who takes time to listen to your concerns, answer all your questions, and go over any test results or lab work. They should also make time to fit you into their schedule or answer your call if you’re experiencing a flare or other issue in between appointments, according to the Arthritis Foundation. And their office staff plays a role here, as well. They should be efficient at passing along your messages, returning your calls, and scheduling appointments with your rheumatologist. They have good communication skills. There are now many options for managing psoriatic arthritis, which increases the importance of shared decision making between the patient and physician, says Craig. “Choices of treatments will depend upon your lifestyle, preferences, disease severity, particular manifestations, medical history, and other constraints,” he says. “You want to find a rheumatologist who will take the time to discuss options that are available, and the pros and cons of each,” adds Craig. They coordinate with the rest of your healthcare team. Because psoriatic arthritis management requires attention to both dermatologic and other systemic disease activity, you want a rheumatologist who is able to coordinate closely with your dermatologist, especially if you have had significant skin involvement, says Craig. “For better or worse, this is often easiest if they are both within the same health system,” he says. Lisa, who has psoriatic arthritis, knows the importance of having doctors who talk to each other about her care. “While my rheumatologist helps me manage my arthritis, my primary care doctor prescribes my pain medication,” she says, as shared on Tippi PsA. “It’s important that the two doctors work together on my treatment plan.” They have expertise and comfort in treating psoriatic arthritis. Although it may seem to be stating the obvious, it helps to have a rheumatologist who is familiar with the management of psoriatic arthritis, says Craig. “This can be hard to assess, but there’s nothing wrong with asking bluntly about a physician’s comfort with the disease process,” he says. “Most of us are happy to seek second opinions if we are not comfortable with managing a particular condition,” says Craig. Your rheumatologist should also be up-to-date on the latest psoriatic arthritis research and treatment, according to the Arthritis Foundation. “I looked for a doctor who had a great education, was knowledgeable, and got great reviews from people on a website,” shared Deeanne on Tippi PsA. “That’s the doctor who worked best for me.”
