Rheumatologist appointment how does this sound?

[petalhorse]

I got referred to a rheumatologist because my GP was querying Ankylosing Spondylitis or Osteoarthritis in my lower back. I've had lower back pain since my 20s. More recently I've had some joint pain plus the ongoing back issues.

I was just wondering how others have found the rheumatologist appointment and if this sounded typical?

He was quite friendly and I spent quite a while in the appointment so I was happy with that. He took quite a detailed history but brushed over certain points. For example, asked about family history (there is a huge amount of arthritis on one side of my family) then didn't really let me describe it. I found he generally was keen to play down symptoms, for example, with lower back pain pretty much saying that all kinds of people have it for all kinds of reasons. With recent joint pain, saying this could just be getting older or repetitive strain and talking about his own aches and pains (!).

The physical exam was very brief with me fully dressed. In terms of looking at my back he asked me to bend forward and when I could touch my knees he pretty much said that's great, your back is fine.

On the whole I felt that because I hadn't crawled in there with hugely swollen joints and looking a complete wreck, he took one look and thought you're basically fine. I have a hard time understanding how daily pain in your 40s can be normal though.

Towards the end we had a fairly long discussion about the difficulty for him of pinning down what's going on but he did agree to refer me for a lower back and sacroiliac joint MRI given the long-term nature of my back pain. He has also ordered more bloods including for the relevant gene for AS. I have had issues with disturbed sleep and he focused a lot on that and has recommended I take Amitriptyline at a low dose but I'm not keen to do that for now and would rather try to identify what's actually causing it.

I guess I will see what comes back from the further bloods, genetic testing and MRI but I was left feeling a bit unsure about this guy in particular. On the other hand I have nothing to compare my experience to and wonder if anyone could share their experiences?

Just bumping!

Yes that’s normal. The testing will help make an accurate diagnosis and is much more useful than a physical examination. In rheumatology we see so much that taking of clothes doesn’t make that much difference.

WRT family history we don’t need to know full descriptions. Just if it’s present. Again the tests will give more information.

WRT to the amytriptyline, don’t be afraid to take it if your sleep is disturbed. It won’t stop you getting a diagnosis or treatment. It helps to relax your body so may also help with any pain related to tension.

I don’t think the doctor was saying there was nothing wrong because you could touch your toes. More that it showed that you still had good range of movement so nothing wrong there.

Thanks so much for your response that’s really helpful and so reassuring. I really appreciate you taking the time to reply. I hadn’t considered the importance of the tests vs the physical exam or the fact that family history being present or absent being the main thing. Thank you again

Yes all very normal and as Bonus has said already, he’ll be waiting to see what the bloods show.

Don’t feel pushed into taking the Amytriptyline if you want to wait a while and see what comes back. I’ve had to learn to push back with my Rheumatologist when in the past I’ve been prescribed medication with very little discussion but I’ve known isn’t right for me.

I hope that you get some answers soon and start to feel better.

Regarding medication once you have exhausted paracetamol and NSAIDs regardless of cause Amitriptylline or Gabapentin are the next steps in the analgesic cascade.
Autoimmune diagnosis has bloods at its cornerstone regardless of clinical examination.

I have RA which started off as palindromic rheumatism and I also have OA.
The initial Rheumatology appointment was very much like yours and subsequently were more focussed on blood results or responses to drugs.
I recently change Rheumatologists and the new one started right back at the beginning.
I have a strong family history of osteoporosis and arthritis but not auto immune. Not sure if there is a genetic factor as they never seemed interested in that.