When to refer to a rheumatologist

1. Diagnostic evaluation of patients with unclear diagnosis:

a. Fevers that are not diagnosed
b. Patients with normal laboratory studies, but local or generalized joint pain and/or swelling
c. Abnormal laboratory findings such as elevated sedimentation rates, anti-nuclear antibodies, rheumatoid factor)
d. Unexplained musculoskeletal pain
e. An unexplained constellation of symptoms including fatigue, rash, fevers, arthritis, anemia, weakness, or weight loss

2. Diagnostic evaluation and long-term management of:

a. Inflammatory Arthritis
i. Rheumatoid Arthritis
ii. Adults with history of Juvenile Idiopathic Arthritis
iii. Ankylosing Spondylitis
iv. Psoriatic Arthritis
v. Inflammatory Arthritis associated with Inflammatory Bowel Disease
vi. Reactive Arthritis
vii. Lyme Arthritis

b. Connective Tissue Disease
i. Lupus
ii. Sjögren’s Syndrome
iii. Mixed Connective Tissue Disease
iv. Undifferentiated Connective Tissue Disease
v. Scleroderma
vi. Dermatomyositis
vii. Polymyositis
viii. Polymyalgia Rheumatica
ix. Antiphospholipid Antibody Syndrome
x. Relapsing Polychondritis

c. Vasculitis
i. Henoch Schonlein Purpura
ii. Polyarteritis Nodosa
iii. Wegener’s Granulomatosis
iv. Giant cell Arteritis
v. Takayasu Arteritis
vi. Churg-Strauss Syndrome
vii. Cryoglobulinemia
viii. Behçet’s Syndrome
ix. CNS Vasculitis
x. Cogan’s Syndrome
xi. Hypersensitivity Vasculitis

d. Osteoarthritis
e. Regional Musculoskeletal Disorders
i. Degenerative disc disease
ii. Radiculopathy
iii. Spinal Stenosis
iv. Bursitis/tendonitis
v. Tenosynovitis
vi. Hypermobility Syndromes
vii. Regional pain Syndromes
viii. Repetitive use Syndromes
ix. Adhesive Capsulitis

f. Crystal-Induced Arthropathies
i. Gout
ii. Calcium Pyrophosphate Dihydrate Deposition Disease
iii. Hydroxyapatite Deposition Disease
iv. Calcium Oxalate Deposition Disease

g. Metabolic Bone Disease
i. Osteoporosis
ii. Paget’s Disease
h. Fibromyalgia
i. Sarcoidosis

3. Confirm diagnosis and help formulate and/or participate in a treatment plan for the following conditions:

a. Complex regional pain syndrome
b. Serum sickness
c. Inflammatory eye diseased. Raynaud’s phenomenon

4. Diagnostic or treatment plan evaluation for rheumatic manifestations of other primary diseases:

metabolic disorders; genetic disorders; paraneoplastic disorders; infectious disorders; neuropathic disorders; and, hematologic disorders.

5. Provide a second opinion or confirmatory evaluation when requested by primary care physicians.

How Can I Make the Most of an Office Visit With a Rheumatologist?
At every visit, it’s important to be honest and open about how you’re feeling and how RA affects your daily life. Here are a few helpful hints.
• Prepare for your visit. Write down questions, concerns, and symptoms to discuss.
• Be open during your visit. Describe the ways that RA affects your life.
• Consider bringing a family member or friend with you. They may help you stay focused and recall important points after the visit.
• Bring a list of the medications you’re taking and their dosages. Include prescription medications, over-the-counter drugs, and supplements.
• Participate in decisions. You and your rheumatologist can come up with a plan that works best for you.
• Follow up after the visit. Call the office if you forgot to ask a question during your visit, or if you are not sure about something the rheumatologist said to you.