Your first rheumatology appointment may seem a little daunting, or even confusing, but understanding more about the types of test and investigations your rheumatologist may wish to carry out can be really helpful.
Dr Poonam Sharma, Consultant Rheumatologist at Peterborough City Hospital, talks us through the tests and investigations your rheumatologist may do at or shortly following your first rheumatology appointment.
So what tests and investigations will my rheumatologist do?
Before explaining what tests and investigations your rheumatologist may do, it is important to understand how axial spondyloarthritis, otherwise called axial SpA, is diagnosed. Essentially, the diagnosis is based on a combination of clinical features, lab tests (blood tests) and imaging (X-rays or MRIs).
At your clinic review, after your rheumatologist has taken your history, they will do a clinical examination. This involves examination of your spine, to check movements of the spine, and then also looking at your other joints. The examination may be tailored according to your symptoms and presence of other medical conditions associated with axial SpA, for example psoriasis or any eye conditions.
Once you have been seen in clinic, a plan will be made to arrange for further investigations. On the day of your clinic appointment, you may be referred for a blood test. The blood test will include checking for a gene called HLA-B27 that’s often (but not always) found in people with axial SpA, and also checking your blood counts, kidney function, liver function and inflammatory markers.
After that, you would be referred for a type of scan called an MRI. This involves using a magnetic field to look at your spine and your sacroiliac joints (joining your lower back to your pelvis), to see if there is any sign of inflammation.
The waiting time for MRI scans can be between 2-4 weeks, depending on where you are seen. When you attend the MRI scan, a radiographer will go through a routine safety checklist with you before going through the scan. The scan usually takes between 20-40 minutes.
The scan is painless. You will lie on a motorized bed which moves in and out of the scanner. You will be able to talk to your radiographer through an intercom. If at any point you experience discomfort or any problems, you can communicate with your radiographer.
You will not get the results straight away, as the MRI report has to be interpreted by an experienced radiologist. Sometimes the diagnosis is straightforward, and your rheumatologist will communicate with you either via a letter, or via telephone, or by a face-to-face review in the clinic.
On occasions, the diagnosis is not straightforward and your case may be taken to what is called an MDT or multidisciplinary meeting. Where a radiologist, rheumatologist and other experienced professionals who deal with axial spondyloarthritis sit together, and go through scans and investigations, to find the best way forward in terms of future plans for treatment or any other investigations, as appropriate.
If you have any questions or concerns about your results, please do not hesitate to contact your rheumatologist. You can usually contact them through their secretaries, or through the advice line for the department.
Check out the blog by Dr Aisling Coy, Consultant Rheumatologist in Salisbury, to discover about how axial SpA is diagnosed.