Whether you just learned that you have a rheumatic disease or have been living with one for a while, you should ask questions regularly throughout your journey. Let’s look at some general questions you can consider asking your rheumatologist.
For patients with newly diagnosed inflammatory arthritis (such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis):
- Are my joint symptoms likely caused by my inflammatory arthritis? For example, low back pain is not typically caused by rheumatoid arthritis, so you would not expect treatment directed at rheumatoid arthritis to help this. The back pain may need to be treated in other ways.
- What are the most common causes of my inflammatory arthritis occurring outside of my joints? For example, psoriatic arthritis is associated with inflammatory eye conditions such as iritis or uveitis; and rheumatoid arthritis is occasionally associated with interstitial lung disease, rheumatoid nodules, and eye inflammation.
- Do I need to be on a DMARD? If you have recently been diagnosed with an inflammatory type of arthritis, you will likely be offered a DMARD (disease modifying anti-rheumatic drug). These are the medications that have been shown to prevent joint damage over time, so it is important to know why you need to be on a DMARD, or why not.
- What can I take for flares of arthritis symptoms? Can I take over the counter medications such as acetaminophen (Tylenol) or NSAIDs (ibuprofen, naproxen)? Can I take prednisone?
- What are potential side effects of my medications? If they occur, is there anything I can do to prevent them so I can continue to take the medication I was prescribed?
- What should I do if I get an infection? Many medications in rheumatology affect the immune system so it is important to ask this question.
- What monitoring is needed for my medications? How often does this monitoring need to be done? Many medications in rheumatology require lab monitoring as frequently as every one – three months.
- What are the goals of my treatment plan? In many cases, the goal of treatment of inflammatory arthritis is remission or near-remission. Occasionally, especially with certain co-existing conditions (chronic infections, kidney or liver problems), this may be more difficult to achieve.
Longstanding or Established Arthritis
For patients with longstanding or established arthritis:
- Can I get screened for complications like osteoporosis and diabetes?
- My arthritis symptoms have been stable for a while, is it possible to reduce the dose of my medications, or discontinue some of them altogether? In some cases, this may not be suggested or possible.
These are especially important questions if you have been taking prednisone for an extended period of time. In some cases, reducing your dosage may be difficult or impossible, but you should still ask your rheumatologist.
Women of childbearing age:
- With my current disease state and the medications I’m taking, am I able to get pregnant?
- Can I use a form of oral contraceptives that contains estrogen (which are sometimes avoided in lupus)? This is important if you are trying to avoid pregnancy.
- I am planning to become pregnant. Which medications should I stop taking, and how long should I be off of them before attempting to become pregnant?
- I am pregnant. Which medications should I continue throughout this pregnancy? Which ones should I stop taking before delivery?
- Which of my medications are safe to continue using while I am breastfeeding?
- What types of comorbid problems am I at higher risk of because of my arthritis? For example, patients with inflammatory arthritis are generally at a higher risk of developing cardiovascular disease, such as heart attack or stroke. While many times the risk factors for these conditions may not be addressed directly by your rheumatologist, asking if you should be screened for things such as high cholesterol by your primary care provider or another specialist is a good step in living well with your disease.
- Is it safe for me to begin or resume exercise? Exercise is important for everyone and in certain cases, it may be helpful to be referred to physical therapy to help improve your strength, flexibility, or balance prior to exercising on your own.
- What advice can you provide to help me lose weight and improve my health? Obesity makes inflammatory arthritis more difficult to control and is hard on your joints. Your rheumatologist may refer you to a nutritionist, dietitian, or other specialist to help manage your weight.
- Can you help me quit smoking? Smoking also makes inflammatory arthritis more difficult to treat. In many cases, your rheumatologist may ask you to address this with your primary care provider, but may know of specific resources available in your area.
About the Author
Paul Sufka, MD is a staff rheumatologist with HealthPartners Medical Group and Regions Hospital in St. Paul, MN and an assistant program director for the University of Minnesota Department of Internal Medicine.