A Change in Pain Symptoms
Over the last month, I’ve noticed a significant increase in my joint pain, specifically my knees, hips, ankles, and toes. Nothing has changed with the medications I’ve been using to keep my RA in check, or my level of physical activity, or the other inflammatory conditions I manage, and this has me feeling concerned.
When I’m focused and working during the day, it’s more of an annoyance than a distraction. But at night, when the house is quiet and I’m winding down, the pain is a deep throbbing that often leaves me in tears.
Deciding to seek care
As an exhausted patient managing multiple autoimmune diseases, I felt frustrated that things had shifted from my status-quo. I knew that I needed to connect with my rheumatologist as soon as possible.
Because this wasn’t a previously scheduled routine follow up appointment, I first struggled to get onto her schedule. The online patient portal offered me an appointment time three months out as her first available, and I felt my heart sink into my stomach.
I didn’t know what to do, so I sent my doctor a direct message electronically.
Explaining these different pain symptoms
I was so hopeful that maybe she could make an exception. In my message, I described with as much detail as possible the symptoms I was experiencing, their characteristics, how long they’d been present for, and any other information I could think of.
Within 24 hours, the nurse messaged me back and offered me an appointment for the following week - either via telehealth or in person. While I’ve taken every COVID-19 precaution possible and have had all of my previous rheumatology appointments since March via telehealth, this felt different. I requested an in-person appointment.
Paying special attention to the pain in my knees
In the days leading up to my appointment, I paid special attention to the discomfort I was feeling so I could better convey it to my doctor. She always asks a lot of questions about my symptoms and, with everything else on my mind, sometimes the specifics are harder to recall. During this time, I noticed that the joints in question, specifically my knees, were swollen, warm to the touch, and somewhat red. I also noticed that they felt stiff when I woke up in the morning and started moving around.
Preparing and going to the appointment
Before my appointment, I made sure to write down all of my current medications (including dose and frequency), the address and phone number of my preferred pharmacy, and my questions for the doctor. This helps me to ensure I’m both prepared and not easily distracted.
When I got to my doctor's office, I stood in line (six feet away from others, of course) to check-in. I was asked to confirm personal information like my address and phone number, for my insurance card, and to do a brief COVID-19 screen (by answering questions and having my temperature taken). When this was complete, I sat down on a chair in the waiting room until my name was called.
The nurse brought me back to an exam room and asked me several more questions - about my current medications, allergies, and the symptoms that brought me in for the appointment. She also took my vitals (blood pressure, pulse, heart rate) and told me the doctor would be in shortly.
Grateful for an in-person assessment
After the doctor arrived, I made sure to convey the number one thing I was concerned about. I let her know that I’d been experiencing more pain than usual, for longer than usual, and I needed some advice on how to manage it. I also needed to know that my current treatment plan was still working, and didn’t need any major changes.
From there, she did a physical exam, manually moving and testing my joints, their flexibility and stiffness, where exactly the pain was coming from (and what, if anything increased or decreased it) and applying pressure in different spots. Overall, I felt really grateful that seeing her in person on this occasion had been a viable option, as it would've been harder (but not impossible) for her to make the same assessments virtually.
Discussing treatment options for the pain
Her conclusion at this time was that my inflammation could use a little support. Rather than change my biologic dose or frequency, she prescribed a short-term dose of steroids, and we talked about several alternative complementary treatment options available to manage my current pain.
We set a follow up appointment for just one month out - much shorter than usual - to keep a close eye on my symptoms. She also indicated that I should reach out in the interim with any questions or if my symptoms increase at all.
Overall, this was fairly typical for an in-person rheumatology appointment. I hope that by hearing about my appointment, you'll have a better idea of what to expect with yours. Also, if you’re new to RA, I’d love to hear what questions you have when it comes to preparing for Rheumatologist visits, and if there’s anything else you’d add to the tips listed above!
Right now, what RA tips would most be helpful for you?