Do You Need to See a Rheumatologist?

Conversations that have repeated themselves throughout my career

There is a question I hear almost every day in my clinic.

"Doctor, do you really think I need to see a rheumatologist?"

Sometimes the patient has been referred by another doctor. Sometimes they have spent months searching the internet, trying to decide whether their symptoms are serious enough to warrant assessment by a consultant rheumatologist.

Often, they are worried they might be overreacting. Just as often, they have been under-reacting for months.

After nearly three decades in rheumatology, I have noticed something interesting. Although every patient is unique, many consultations begin differently — yet as the conversation unfolds, familiar themes begin to emerge. Over the years, these conversations have repeated themselves so often that they have become almost familiar.

Perhaps you will recognise one of them.

"I thought it was just part of getting older."

This is perhaps the most common conversation of all.

A patient in their forties or fifties tells me that their hands have gradually become stiff and painful. They assumed it was simply the price of getting older.

That assumption is understandable. But inflammatory arthritis is not a normal part of ageing.

One of the most rewarding moments in clinic is telling someone that what they assumed was "just ageing" is actually a treatable medical condition.

"My blood tests were normal."

Many people are understandably reassured when they hear that their blood tests are normal.

Blood tests are valuable tools, but they are only one piece of the puzzle. Some patients with inflammatory arthritis have completely normal inflammatory markers. Others may not have the antibodies commonly associated with inflammatory arthritis.

As rheumatologists, we treat patients — not laboratory results.

"I feel better once I start moving."

Most injuries improve with rest. Inflammatory arthritis often behaves differently.

Many patients tell me, "The first hour is the worst." To a rheumatologist, that pattern is an important clue that inflammation may be present.

"Nothing looks swollen."

Early inflammatory arthritis is often much more subtle than people expect. The swelling may be obvious to an experienced clinician long before patients recognise it themselves.

"I've been told it's osteoarthritis (wear-and-tear arthritis)."

Sometimes it is. Sometimes it isn't. Some patients have inflammatory arthritis that resembles osteoarthritis — and some have both conditions at the same time.

"It's only one joint."

Inflammatory arthritis does not always begin with many joints. A single persistently swollen finger, wrist or ankle may deserve investigation.

"Have I waited too long?"

While we always prefer to diagnose inflammatory arthritis early, seeking help today is almost always better than waiting another six months.

A final thought

One lesson that years of rheumatology practice have taught me is that patients rarely regret seeking an opinion early. Much more often, they tell me they wish they had come sooner.

Joint inflammation does not always announce itself dramatically. Sometimes it begins quietly — with stiff hands in the morning, a finger that no longer bends quite as easily, or an ache that mysteriously improves after you start moving.

Those small clues are your body's way of asking not to be ignored.

If these symptoms sound familiar, an assessment by a consultant rheumatologist can help determine whether inflammation is present and, if necessary, begin treatment before permanent joint damage occurs.

Listening to those early clues can make all the difference.