We asked Dr Elizabeth Reilly, Consultant Rheumatologist in Bristol and axial spondyloarthritis researcher in Bath, to talk us through what you can expect from your first appointment, including top tips for how to prepare. Although you may not receive a definitive diagnosis straight away, this first appointment is an important step on your path towards finding the right answer.
Who will I see and how long will it last?
Some details may vary slightly depending on where you are seen, but most often your first appointment will be with one of the team rheumatologists and last between 30-45 minutes.
Following the appointment with your rheumatologist, you may also be referred on to other members of the rheumatology team, for example to see a physiotherapist who can offer guidance on exercise for your general health and to help manage back pain. Rheumatology specialist nurses will also be involved in your treatment and are an excellent point-of-contact between appointments if you need further support.
What sorts of questions will I be asked?
You will be asked a variety of questions about your symptoms. For example, do you have any joint symptoms or back pain? How long have these symptoms been present, and do they change day to day? Have you noticed any factors that make them better or worse, and do you experience any symptoms at night? You may also be asked some questions which sound unrelated to these symptoms – for example, do you have skin rashes, or any problems with your eyes or gut? You will also likely be asked about any relevant family history, as some of these conditions can run in the family.
It is also important for your rheumatologist to understand the impact that these symptoms are having on you day-to-day, so you will be asked about your work situation and your social support network, for example, whether you have any relatives nearby.
Your rheumatologist will also talk about risk factors, for example, asking whether you smoke or drink much alcohol. They will also likely ask whether you take any regular exercise, as exercise is an important way that you can help yourself and your symptoms.
What examinations will be done?
As part of your appointment, there will also be a physical examination – usually examining your joints and your back. You may also be asked to complete a variety of movements to demonstrate your range of motion. Your heart and lungs will also be checked by listening to your chest and back. If you have mentioned any other symptoms, there may also be other examinations that are relevant.
Usually, other tests need to be done before your rheumatologist can give you a definitive answer for why you have joint or back pain. This may involve blood tests, x-rays, MRI scans or ultrasound scans.
Some of these tests can be done on the day, and others will require another appointment at the hospital. But it is usually possible to talk about treatment options to manage your symptoms in the meantime. This might include discussing medications, and getting written information on these as well.
It can be really helpful if you bring an up-to-date list of your medications with you, even including those that may not be related to your symptoms. You can review this list with your rheumatologist, and it can have an impact on what treatment options there are for you.
I’ve had my first appointment: what next?
Usually, during your first visit, a subsequent appointment will be planned to discuss any results and to determine the best next steps for you. Your rheumatologist may need to see you more than once to make a definitive diagnosis. However, this first appointment is an important step, to get you on the way to appropriate treatment.