Ask the Expert: When Should You See a Rheumatologist?

physician speaking to spine patient

Knowing when to see a rheumatologist can be tricky – especially if you don’t know what a rheumatologist is or what diseases they diagnose and treat! My own friends and family didn’t know much about this field when I chose to go into it and I’ve been in many social situations where I’ve introduced myself as a rheumatologist and have been met with blank stares in return.

So first off, a rheumatologist is a doctor who specializes in both musculoskeletal disorders and certain autoimmune conditions. In its simplest form, we can be described as “arthritis” doctors, but really we actually do much more. Here are some reasons to see a rheumatologist:

You have been diagnosed with arthritis or a rheumatic disease

There are over 100 types of arthritis and rheumatologists specialize in the care of many of these conditions. Examples of diseases that may be treated by a rheumatologist include rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), vasculitis, Sjogren’s syndrome, gout, scleroderma, antiphospholipid syndrome (APS), myositis, sarcoidosis, polymyalgia rheumatica (PMR), and temporal arteritis (or giant cell arteritis). We take care of many other rare diseases as well.

You have joint pain and/or swelling

Joint pain and swelling may be the first symptoms of rheumatic disease. We know that early diagnosis and treatment of arthritis are the best ways to ensure good outcomes in our patients. If you are suffering from joint symptoms, consider scheduling an appointment with a rheumatologist for an evaluation.

You have been told you have certain abnormal blood test results

Certain symptoms or complaints will prompt primary care doctors to order blood tests that may indicate the presence of rheumatic diseases. Examples of these blood tests include: antinuclear antibodies (ANA), rheumatoid factor (RF), and erythrocyte sedimentation rate (ESR). If you have tested positive for one of these tests, consider meeting with a rheumatologist to determine if your symptoms might indicate an underlying condition.

You are having trouble figuring out what’s wrong

Rheumatologists treat many rare diseases that are difficult to diagnose. We often act as detectives to help put together the pieces of a complex puzzle of symptoms and lab tests. Seeing a rheumatologist early on can help patients avoid waiting months to years before receiving a diagnosis. Gathering the clues and helping patients figure out what’s going on is one of my favorite things about being a rheumatologist.

I absolutely love the opportunity to help my patients figure out a diagnosis, teach them what to expect from their diseases, and devise treatment plans to get them feeling better. If any of the points listed above applies to you or a family member, consider scheduling an appointment with one of the rheumatologist at Hospital for Special Surgery or ask your primary care doctor to help find a rheumatologist near you.

Dr. Alana LevineDr. Alana B. Levine is a rheumatologist at Hospital for Special Surgery. She specializes in rheumatic autoimmune diseases including systemic lupus erythematosus, antiphospholipid syndrome, undifferentiated connective tissue disease and rheumatoid arthritis.

Topics: Rheumatology
The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. How can I convince my gp to refer me to a rheumatologist? In 2011 I was diagnosed with Arthritis of the Lower Lumbar which was painful but manageable. April of this year tests showed aside from that I have scoliosis on the right and my dr revealed degenerative disc disease. Way too much pain now but i just keep being given medication after medication. None of which are helping me.

    1. “Many types of physicians treat what you have- rheumatologists, orthopedists, physiatrists, pain management doctors, and others- so your GP may feel you already have seen someone with expertise. Or your insurer may not approve a referral, or something else. Most likely it’s something about our health care system rather than your illness that is holding back a referral. That said, uncontrolled pain or decreased function are two good reasons for referral. For the latter, itemizing what you used to be able to do and comparing that to what you now can do, with a timeline, is a good starting point for discussions with your GP and/or your insurer, whichever is declining to make or permit a referral.” – Dr. Michael Lockshin, Rheumatologist

  2. I am 44 years old and in good health, excellent cholesterol, great BP and HR. I have been struggling with bilateral forearm pain for well over a month with intermittent numbness in the tips of my fingers. I struggle to “grab” items, open yogurt, and jars, but I am not sure this is true muscle weakness or due to the severe pain I am experiencing in my muscles. My skin is warm with normal color and there is no obvious swelling. I am considering going to a neurologist or a rheumatologist, but am not sure where to start.

    1. “It could be something as simple as carpal tunnel syndrome, in which case either would be fine. However, if it is not carpal tunnel it is related to arthritis or something else, a rheumatologist. We’ll have a better overview of the other possibilities” – Dr. Michael Lockshin, Rheumatologist

  3. Hello. I am a 45 y/o female. About 16 years ago after my second child was born, I started getting really bad leg pain on both legs. I saw a rheumatologist for a few years and keep doing ANA test last on me. I later moved to Florida and around 2-3 years after everything started I was finally diagnosed with Lupus. Had my 3 child shortly after that with no issues at all, I was on plaquenil and steroids. Few years went by and I thought it was weird that I was on such a long remission since I had stopped my mess when I was pregnant the last time, and saw another rheumatologist who ran labs and said I didn’t have Lupus. Now years after I have become a nurse and all the stress of nursing school while raising a family and maintaining a household while also working part time on night shift took a toll on me or so I thought. I have chronic back issues which I manage with tramadol, but my joints are usually bothering me, pins and needles sensation in my hands and feet, very fatigued when not at work, so I asked my PCP to run some tests which he did. RA factor is positive and so was the ANA, can’t remember the tiger numbers but there was something about “speckled”, also SED rate was elevated, so now he’s referring me to the rheumatologist. What tests should I expect to finally get a correct diagnosis?

    1. “You have already started getting the right tests; it is best that the rheumatologist makes choices after he/she sees you. If you have a speckled ANA it is likely that you will have one or more of the following other antibodies: ANTI-SMITH, ANTI-SSA/RO, ANTI-SSB/LA, ANTI-RNP. Whichever one of these is positive (if any) will lead to the more refined diagnosis.”- Dr. Michael Lockshin, Rheumatologist

  4. I went to get routine blood work just to check everything out and have good base line test because i was turning 40. Everything checked out great except i had a hs-crp of 19.1 and my fibrinogen level was 553. all my cardiac stuff looked great and i didn’t have any symptoms so my Dr. ran some test that he said would be for things like RA. He called a week later and said that those checked out ok so he wanted to rerun the crp and my esr. Nurse just called and said that the doctor would be contacting me soon with a referral to a rheumatologist . I think she said my crp had increased and my ESR was 40. I am 40 and could stand to lose 40 :-/ i am active, i do cross fit 3 times a week, i have 2 teenagers and a cattle ranch. I do have some pretty sever pain that comes and goes in my feet and ankle but it is mostly in one foot. i do have aches and pains but i assume all over weight 40 year old active school teachers do. Any thoughts on what could be going on here? Do you feel as though i should see a rheumatologist at this point of just monitor those levels?

    1. Hi Jennifer — It sounds reasonable to see a rheumatologist. The ESR and CRP are blood tests that measure levels of inflammation in the body. They are not especially specific, meaning that they could be from inflammation due to infection, injury, or a condition like rheumatoid arthritis, psoriatic arthritis, or lupus. If you are having some joint pains, even if you feel that the pain is probably related to weight or activity, it makes sense to have a rheumatologist take a look at you and possibly order additional blood tests to make sure nothing else is going on. Good luck!

      1. I go on the 11th and I am ready to see him. My joint pain has increased and comes and goes to the point i feel like i am crazy some days. I am certainly ready to find out what is going on.

  5. Hi, I am freaking out right now. Just got a call from my doctor and my ANA is 1:160. I don’t know what that means. 20 years ago I saw a rheumatologist who THOUGHT I had lupus….I had a positive ANA, weird hive like rashes and protein in the urine. He wasn’t 100 percent sure at the time. I didn’t have any problems with the sun, no malar rash and a few other things. Like I said that was 20 years ago. Anyways, I never did take the medicine he wanted to start me on to treat me for lupus because I wasn’t gonna take it unless he was almost positive that I had it and he wasn’t. The past 20 years… problems at all with any of that. Rashes went away, no protein in urine. Had an ANA test done about a year ago and it was NEGATIVE! I about fell out of my chair. That was the first time I had ever had a negative result. Anyways, last week they did another ANA test on me, at my request because one of my fingers is a little painful in the joint and it came back positive at 1:160. SERIOUSLY FREAKING OUT. I AM SO SCARED. I am 37 years old and female. I don’t want lupus or any of the other diseases. I should mention, I never had any weight loss or weight gain. Always remained around the same weight. Help, please. Tell me some good news, if there is any?

    1. Hi, I am not a doctor- but I am a patient. I have had a positive ANA off and on for almost 9 years now. You should most definitely try to see a rheumatologist- yes they might tell you you have a “scary” disease, but chances are if you are not having scary symptoms right now- you will leave no worse off than you are now! If you are having symptoms, then they might make you feel better or prevent you from feeling worse.

      My advice would be: go to the rheumatologist, make sure they walk you through everything and if something frightens you- tell them, they might be able to soothe your nerves. 1:160 isn’t that high of an ANA, and some (mostly women) have positive ANAs without having an autoimmune disease. Not everyone who has an autoimmune disease has every symptom.

      Most of your first procedures with a rheum in your case will likely be more bloodwork, a physical type full body exam like at your PCP/GP’s, probably a hand x-ray- all relatively painless things (unless needles bother you, in which case talk to your primary doc about that first and getting a lidocaine cream), and possibly an ultrasound of the effected joints which is also painless.

      Nobody really wants an autoimmune disease, so it is fair to be afraid of the unknown and possibly having one, but remember these conditions are not very common, you might just have a little osteo or another condition if you only have one specific finger. Since it has been suspected before, you should definitely stay up on your health- get routine blood work every year including rheum panel and a physical, and if your doc says meet with a specialist and you can afford it- go, if not figure out a way to find one you can afford. It is really important! Deep breath- you will make it through this!

    2. Hi Ashley — We’re sorry you are going through this! An antinuclear antibody (ANA) is a blood test that can be run when certain autoimmune diseases, such as lupus, are suspected. An ANA may be positive in people with other conditions as well, such as rheumatoid arthritis or autoimmune thyroid disease. A positive ANA alone does not confirm a diagnosis of lupus. Lupus is a complicated disease that requires the presence of symptoms or physical exam findings as well as abnormal blood tests. Given your history, I think you should schedule an appointment with a rheumatologist to help determine if you have lupus. Good luck!

  6. I have severe pain that comes and goes in different joints. It will be in my lower back/pelvis for awhile then go away then few weeks later severe pain stiffness in my right knee with popping and cracking then go away. Then turn up in my feet especially the soles and back heel. It seems to go from one area to another like a cycle. Including my fingers,elbows and wrists and center of my chest. I also have red dry patches on my one heel and my ankle on another foot and my scalp they are constantly itchy and flaky. Only 34 years old and been having this for about a year now. Been under a lot of prolonged stress. Not sure if its just stress and im over reacting

    1. Hi Kristin- I am sorry to hear that you have been going through this for a year. The combination of joint pain and rashes can be seen in a variety of conditions, including psoriatic arthritis and lupus. You should consider making an appointment with a rheumatologist to evaluate you for an underlying cause of your symptoms.

  7. Hi, I can save you the trouble of answering my post. Between my primary care provider, neurologist, neurosurgeon, & orthopedic surgeon we have been able to determine the cause of my medical problems so, I won’t be needing your help after all. Thank you, Rebecca Williamson

  8. I had a positive ANA Direct so my primary ordered a ANA Comprehensive Panel which came back Anti-SS-B positive 1.3. My urinalysis showed 2+ WBC Esterase and microscopic WBC 6-10. I’ve been having a lot of spine issues and an MRI showed herniated disks with annular tears,L1/2,L4/5,L/5/S1. Bulging disk L3/4 and multilevel nerve root sheath cysts. I’m 42 years old and up until recently have been very active. Do you suggest I see a specialist at this point, if so what kind? Do my findings point to anything specific?

    1. Hi Tracy-
      An important question is why you had an ANA checked to begin with. Did/do you have specific symptoms that led your doctor to order this test? A positive ANA can be found in people with autoimmune rheumatic diseases, like lupus, rheumatoid arthritis, or Sjogren’s syndrome. Other people might have a positive ANA with no symptoms consistent with rheumatic disease at all. A rheumatologist may be able to help tease out whether your symptoms and labs together are suggestive of a rheumatic condition. I would recommend seeing a physiatrist or spine specialist to evaluate your lumbar spine issues.
      -Dr. Levine

  9. Hi, I’m really hoping you can help me see what might be happening! I seem to get referred back and forth etc…I am 60 yrs old, I have had 2 cervical disc replacements, one at 45 yrs old, another at 50 yrs old. Initially, the surgery was an amazing success!! However, gradually over time my neck is very painful again. Now to the new problem, at the beginning of April I had a pretty serious fall which resulted in intense lower back pain that has not let up since that time. An MRI showed that I have 2 disks bulging, one of which is pressing on the nerve root that controls bladder/bowel function. (I don’t have to explain the nightmare that goes with that)! But, and here’s where I’m confused and frustrated, my neurosurgeon doesn’t feel it’s pressing deeply enough to be causing the severity of my symptoms so, is referring me to a rheumatologist. Can you please tell me what a rheumatologist can do for me? My neurosurgeon said I also have spinal stenosis (BTW; I have fibromyalgia also)

  10. I have mild psoriasis which has started to become moderate these past few months. I am starting to develop it on my nails as well. My dermatologist prescribed me methotrexate just to see how I would respond to it. I’ve also started feeling pain (though no visible swelling) in my knee and fingers. It only hurts when I move them. Could this be Psoriatic Arthritis? Would you recommend that I schedule an appointment with a rheumatologist?

    1. “No definite diagnosis can be made without a formal evaluation. You would certainly benefit from a rheumatology evaluation regardless of whether you have psoriatic arthritis, as your physician can direct you in managing non-inflammatory conditions.” – Dr. Dee Dee Wu, Rheumatologist.

      If you would like to consult with a physician at Hospital for Special Surgery (HSS), please contact our Physician Referral Service at 888-720-1982 for further assistance.

  11. I was just givent this diagnosis Mild degenerative endplate spurring of the mid thoracic spine.(mild arthritis. My PCP requested lab work due to family history of Rheumatoid Arthritis. Will I have to see a Rheumatologist?

    1. “You don’t say how old you are, but that description of your upper spine is very common in anybody over 30. It has nothing to do with rheumatoid arthritis. If that’s all there is, you don’t need to see a rheumatologist. If there is something more, then discuss once more with your PCP.” – Dr. Michael Lockshin, Rheumatologist

  12. After losing almost total hearing in my right ear, my E.N.T. referred me to a rheumatologist because she found an elevated number in my blood. I don’t recall the blood part, but a normal ratio is 1 in 40, and mine is 1 in 160. She said it had a possible connection to Lupus. I apologize for not knowing more about my own condition, but does anyone see an explanation as to why I was referred to a rheumatologist? I am 68 years old. BTW, the hearing loss came after a typical winter cold. Nothing out of the ordinary, but I was put on a 12-day heavy duty steroid program that did not improve my hearing.

    1. “I’m sorry about the hearing loss. Most likely, a test you are referring to is an antinuclear antibody test, which is a screening test for lupus. The likelihood of a positive test increases as you get older, but it does not mean the risk of lupus is more. The numbers refer to the number of times the blood is diluted, starting at tenfold dilution (1:10), and then doubling (1:20, 1:40, 1:80, 1:160, etc.). At your age, it is not at all meaningful unless it is more than 1:80, and it seldom means anything if it is less than 1:640. If it is that high, then it doesn’t make a diagnosis of lupus. What I does indicate is a need to do additional tests and examination. In other words, the result you received, at age 68, is not terribly important. There is a circumstance in which sudden hearing loss is due to an autoimmune illness, such as lupus, which is why ENT doctors do the test. Your doctor is being abundantly, probably over, cautious in asking you to see a rheumatologist (rheumatologists treat lupus). I suspect the rheumatologist will find nothing further that suggests you have lupus or any related illness.” – Dr. Michael Lockshin, Rheumatologist

  13. Hi, I have m.s., fibroymalgia, antiphospholipid syndrome, and now after having a huge lump removed from my right hand, the tests results from the biopsy are saying, “suggestive mitosis degeneration /regeneration. ” my hands have been drawn up for about a year. I hand drop wrist in my right , but since the surgery, I can now lift it. My fingers still don’t move. Nerve conduction tests are normal. I have surgery tomorrow on my left hand for the same reason . Why would my doctor be sending me to a rheumatologist? Thanks, Christi.

    1. “I’m sorry, but the ‘suggestive mitosis degeneration/regeneration’ doesn’t make sense to me-there must be something more. As a rule, the doctors who know most about hand function are rheumatologists and hand surgeons (who are subspecialists in orthopedics or plastic surgery), so a rheumatologist would be a good place to start to figure out what is going on. Antiphospholipid syndrome and fibro would not likely account for wrist drop; MS might. Neither would account for the lump, so it sounds like a more detailed evaluation is in order.” – Dr. Michael Lockshin, Rheumatologist

  14. Hello! I am 27 year old female who recently had a ANA test positive as well as the anti-chromatin blood test be positive too. My PCP wants to send me to a rhumatologist. What do you think would be the benefits of that?

    1. “The ANA is a screening test for lupus and related diseases. Low positive tests can occur in up to about 10% of a population, the higher numbers occurring in people of color and in people greater than the age of fifty. The ANA itself does not mean very much, unless it is confirmed by other abnormal tests. As a rule, anti-DNA or anti-Smith antibody (the confirming tests) occur in lupus patients. There are claims made that the antibody to chromatin also occurs in lupus patients, but this test is much less definitive, than is anti-DNA or anti-Smith. If you have symptoms and/or other blood tests that make a doctor suspicious for lupus, then a rheumatologist can sort that out and decide whether you do or do not need treatment. If you have no symptoms and no other abnormal tests (for instance, abnormal blood counts or urine tests), most likely a rheumatologist will say that nothing needs to be done. If the ANA is only weakly positive (generally defined as a titer of 1:80 or less [that is, diluted 80-fold, starting at 1:10 and then doubling, to 1:20, 1:40, 1:80, and so on], it is unlikely to mean anything important. If it is much more strongly positive, it is probably worthwhile to have further tests done.” – Dr. Michael Lockshin, Rheumatologist

  15. i have been sick for a long time. Slowly has come to surface. i was never a bleeder until over a year ago. from small scrapes to just to taking blood. i bleed like i have serious cut, they heal for weeks. they took me off all blood thinner and it hasn’t changed. literally over night i ended up in ER with my bp 118/100 its all unexplained Ice gained over 80 lbs overnight ghettos some more illness. they said it wasn’t lupus is ms but more serious. and i went blank know have to see Rheumatology what should i prepare for I’m very scared

    1. “I’m sorry to hear that. Were you on blood thinners because of the clotting and are you still on them? Sometimes that happens when a person makes an antibody to clotting factor. For example, when a patient with antiphospholipid syndrome who clots too much goes on to develop an antibody to prothrombin (factor II, a clotting factor), and hence bleeds. The numbers in your note about blood pressure are not a cause for concern. Regarding weight gain, the only way that would happen that rapidly is if you put on a lot of fluid, which could occur if a vein got blocked (for instance, in your abdomen, filling your abdomen with fluid) or legs, or if your kidneys stopped working. Even so, 80 pounds is a huge amount. If your doctors told you to see a rheumatologist, they are probably thinking of something along the lupus or antiphospholipid syndrome line, but more than that, I can’t say.”- Rheumatologist Dr. Michael Lockshin

      1. Thank u so much. The Dr ruled out lupus and ms and said it was more serious. I have appointments Wed to a rheumatologist

  16. Hi I’m freaking out my dermatologist did blood work on me and requested I see a rheumatologist . Why would that be ?

    1. “Hi Amy, It isn’t unusual for a dermatologist to suggest a rheumatologist just to be sure whether a rash might be related to a systemic rheumatic illness, and it isn’t unusual that the dermatologist would do blood tests as well. A lot of rheumatic diseases begin with rashes; most likely the dermatologist is just being sure. Rest assured, there is no reason to freak out just because of the referral.” – Dr. Michael Lockshin, Rheumatologist.

  17. I’ve had deep, intense and widespread (systemic)pain for about 6 years, now! Ugh! Because of all the trigger points and feeling like I’ve been hit by a truck, I’m wondering if fibromyalgia may be at play. I have, now, developed such joint pain and loss of strength in my hands. I’ve asked my different providers, over the years, about these symptoms. I feel I’m not taken seriously because no one has ever addressed these (painful) concerns. Should I fast forward to a rheumatologist? It’s a good thing I have a high pain tolerance. Ugh! Thank you!

    1. Hi Valerie- We sent your questions to Rheumatologist Dr. Michael Lockshin, who has responded with the following: “I’m sorry to hear that. Fibromyalgia generally would not account for joint pain or loss of strength in the hands. With that being said, the answer is yes, please do see a rheumatologist. Rheumatologists are specifically trained to evaluate widespread pain, especially in the joints.”

  18. Hello, Please help!
    I have had upper thigh and hip pain for about 9 months now. I am 48 years old & overweight. It started out bilateral in the hip, pelvic and upper thigh area, now it is mainly in my left upper thigh on the front. It burns, and aches 80 % of my day, and wakes me up at night in pain. I had X-Rays done, as my PC thought it may be sciatic nerve or osteoarthritis. My x-rays came back normal. I had a bond density text done 2 weeks ago, and i am below 10% for women my age and my doctor said my bones are pretty bad. He explained that osteoporosis is silent and it couldn’t be causing my thigh and hip pain. I was referred to an Ortho Dr. by my endocrinologist, but I feel like its not bone and don’t want to pay for anymore unnecessary tests. Where do I go from here? I am really getting worried, as I know there is something going on, I just don’t know what, or what to do next. Mt primary care doctor has just dismissed my situation to weight now. It came on all of a sudden as well, I woke up one day with my hip and thigh burning. Thanks in advance for any advice you may have.

    1. Hi Donna, thank you for your question. According to Dr. Theodore Fields, Rheumatologist, “it is not uncommon for pain in the hip and thigh to be difficult to sort out, with common causes being both the hips and the lumbar spine. It is difficult to say too much without examining you, but if you have pain moving the left hip, it would likely be reasonable to look into the hip joint further, as with an MRI, looking for things you wouldn’t see on x-ray, such as mild arthritis or a tear in the socket (labrum). As you note, it’s best to have a consultation with an orthopedist, and their exam can help to localize the problem.”

  19. Hi I’ve recently had several blood tests taken all seem normal apparently but I’m wondering whether to ask my gp for a referral as I’m in agony all day everyday back legs neck shoulders hands it’s so painful some days could this be a arthritic problem I’ve only known my mother to have arthritis thank you Sharon

    1. Great question, and yes, Sharon! Rheumatologists deal with people who diffuse severe pain in the extremities and joints. A referral would be useful in determining what the problem is and how to treat it.

  20. Hello, I am 21 years old with a family hx of seronegative rheumatoid arthritis and recent dx. Starting in January I experienced severe wrist pain that began radiating down into my fingers and was put on steroids. My hand/wrist responded wonderfully and felt better. Its about a week later and although the pain is not as severe I am having more stiffness, numbness, and have began dropping things repeatedly. I was told I had 2 options. 1. waiting it out and treating with NSAID’s or 2. Seeing an actual Rheumatologist. I don’t know what to do. Im so young but have seen the havoc RA reaps. I know that my blood work will come back negative as well. It always does no matter whats going on with me. I also suffer from IBS, and fatigue. Im trying to finish college and get into graduate school. Im just so lost as what to do or decide. RA medications are hard on you and NSAIDs aren’t working. I have so many mixed feelings and just recovered from a prior health problem. I am so tired of being poked and not having answers. Do you have any insight? Does it sound like my flare up/ illness is getting worse? It just seems to move around and be so illusive. I don’t want to wait to be treated but I also just want to see if it goes away:(
    Thank you,

    1. Hi Emily, thank you for reaching out. Dr. Michael Lockshin, rheumatologist, says: “From what you describe, I’m not at all convinced you have any kind of arthritis. It may well be carpal tunnel or something similar. There are also injuries and infections and other causes of the symptoms that you described. You don’t have to have positive blood tests to make a diagnosis of rheumatoid arthritis. In fact, your family history of “seronegative” rheumatoid arthritis is an example of making the diagnosis without positive blood tests. A rheumatologist would be able to figure out what the cause of your symptoms might be, and treat you appropriately. It may well be that there is no need for what you call ‘RA medications’.”

  21. I am 27 years old and have been experiencing chronic fatigue for over 7 years. I have had my blood work checked on two different occasions, but there have never been any alarming abnormalities. Over the past year, I have developed extreme muscle pain in my lower back, making it nearly impossible to bend over at times, as well as my shoulders and neck. I have been seeing a chiropractor as well as a holistic doctor who specializes in adjustments to reduce muscle pain. While it can help at the time, the pain continues to come back. Among my other symptoms are memory issues, cognitive issues such as difficulty communicating, tenderness in my shoulders and neck, and my hands tend to go numb easily. One doctor in the past referenced fibromyalgia with my symptoms, I just don’t know who I should see to help figure out my health issues. Is a Rheumatologist recommended? Also, do you have to have a referral to get an appointment with a Rheumatologist?

    1. Hi Brittany, thank you for your questions. Dr. Michael Lockshin, Rheumatologist, says: “While shoulder and neck pain are fairly common with fibromyalgia, low back is not so common, and suggested something else might be going on. The same thing can be said for the numbness in your hands. So yes, rheumatologist is a good place to start. Whether rheumatologists in your area require referrals, or your insurance requires approvals, depends on your local situation. Your primary physician, your insurer, or the rheumatologist you choose to call can answer the question for you. You can find names of rheumatologists in your area by going to and clicking on the ‘find a rheumatologist’ tab.”

  22. I am a 25 year old female. I have chronic fatigue and extreme back pain. I was diagnosed with juvenile arthritis at the age of 20. I was having vision problems (iritis) and was ordered to do blood work when I was diagnosed with juvenile arthritis. Now, 5 years later I have chronic fatigue. My ANA test came back positive and my general physician is sending me to a rheumatologist. I have heel pain in my left foot (my doctor said its from flat feet) I have really bad back pain. I also got diagnosed with vitiligo about 5 years ago and it has spread. My general physician thinks it’s from an arthritis flare up. I workout and eat healthy, but the workouts only seem to make me more fatigued. I don’t know what to think of all of this. I’m really worried. I’m not sure what to think about going to a rheumatologist at the age of 25. I’m also the concerned about the positive ANA test.

    1. Hi Erica, thank you for your questions. Dr. Michael Lockshin, Rheumatologist, says: “Sorry to hear about your problems. Actually, I think a rheumatologist is where you should go, for several reasons. First, juvenile arthritis is not a one-time thing, but is likely to continue, and foot (especially heel) and back pain could be manifestations of that. Second, many patients with juvenile arthritis have positive antinuclear antibody tests; a rheumatologist can determine other that is the cause or something else is going on. Third, the fatigue is part of the problem. Fourth, vitiligo is another autoimmune disease, but there are other reasons for pigment change, some of which might be related to juvenile arthritis, or its treatment, so it is worthwhile checking that out. I’m not sure what your concern about seeing a rheumatologist at age 25 is. In fact, rheumatologist see quite a number of young people for exactly the reasons you are describing.”

    2. Hi Erica i, am not a physician. Having said that I sympathize with your symptoms as I am going through much similar presentation. Will pray for you. I am also planning to see a rheumatologist.

  23. I was wondering if you have to have a referral from your primary care physician to see a rheumatologist or can you just make an appointment with one? I have a fairly new (to me) doctor and I feel like she just isn’t quite listening to my concerns. I have suffered with multiple joint pain and swelling along with severe fatigue and also mild fever/night sweats for quite some time now, it gets to the point it becomes unbearable. I’ve told her my concerns as my family has a history over 5 generations deep with rheumatoid arthritis but since my RF test came back negative it’s like she’s not listening when I know not everyone with RA tests positive, and my Sed Rate and C-Reactive Protein levels have been 2 to 3 times higher than normal for over 5 yrs now.

    1. Hi Jessica, thank you for your wonderful questions. We will send them to Dr. Levine for her remarks.

    2. I am not a doctor but I can tell you- whether you need a referral depends on your health insurance plan (US) or health system if you are outside the US. If I were you with your symptoms I would firmly and politely request a referral to a Rheumatologist for evaluation if you need one- you will need to check with your insurance company to find out. If your doctor refuses, it may be worth changing pcps and trying again. If your doctor is dismissive of your chronic health issues, they may not be the right doctor for you.

    1. Hi Jean, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “There has to be a mistranslation here. RNA (ribonucleic acid) is a normal body constituent–it is the family of molecules that assist DNA (deoxyribonucleic acid) to make proteins. In that sense, everyone has RNA. Most lupus patients have antibodies to DNA. If you have these antibodies, by definition you have lupus. Occasionally people have antibodies to RNA. They don’t tend to mean very much. Thirty or so years ago there was a lot of interest in antibodies to RNA, but, when it became apparent that they didn’t cause trouble, most doctors quit measuring them, except for research purposes. It is possible that your doctor did measure this antibody, though most laboratories don’t do it anymore, and that you do have antibodies to RNA. If so, don’t be worried about it. Another possibility is that your doctor meant that you have antibodies to RNP (ribonucleoprotein), the protein that carries RNA around in your body. That antibody is associated with what is called mixed connective tissue disease, an illness that has features of lupus, dermatomyositis (muscle inflammation), and scleroderma, but is different from those three illnesses. I hope this helps. It would be best for you to ask your doctor to explain what he or she meant. If it is different from what I guessed, ask us again.” If you wish to seek a consultation at Hospital for Special Surgery, please contact our Physician Referral Service at 800-796-0482 for further assistance.

  24. I have been dealing with osteoarthritis for years, I also have celiac disease, usually it gets easier in the summer but it seems to get worse every year I have tried just about everything in the past I’ve had numerous blood test done to no avail. I never know where the pain is going to be, I will be talking to my Dr today hopefully about seeing a rheumatologist any advice would be great.

  25. Hello I am 26 years old and I joined Crossfit 14 days before being admitted to the hospital for Rhabdomyolysis. At my 7th Crossfit class we did ring rows, rowing machine, and push-ups as many as we could do during 2 minute intervals 3 times. I did 101 ring rows, 75 push-ups, and burned 55 calories on a rowing machine. I performed these exercises until failure multiple times. After class I had usual soreness. 2 days after I noticed swelling in my biceps just above the elbow. We went to the ER and asked to get CK levels tested and they came back at 32,000. I was admitted to the hospital and put on IV fluids for 3.5 days. My CK was at 1,000 5 days after I was admitted with a CK level of 32,000. I was tested 13 days after original admission and my CK level was normal 94. I have never had this happen before, I was new to Crossfit , I was in moderate not great not terrible shape before Crossfit. Should I see a rheumatologist because Rhabdomyolysis is so rare?

    1. Hi Ted, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Although it is possible that it was the exercise alone, there are some genetic causes of rhabdomyolysis, which could be important to know about. You should see someone who is an expert in muscle disease. It could be a rheumatologist or a neurologist- both see this type of illness.” If you wish to receive care at Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  26. Thank you for your reply.
    I am considering going for hyaluronic acid injections to the knees before going ahead with knee replacements. From what I have heard, both orthopedists and rheumatologists can do this procedure. Is this correct and is one better-suited to do this than the other? Thank you.

  27. What is the difference between rheumatology and orthopedics, and rheumatologists and orthopedists? Which would be more appropriate to see about osteoarthritis of the knee and knee replacement options? Thank you.

    1. Hi Mary, thank you for reaching out. The difference between rheumatology and orthopedics is that rheumatology focuses on the study of rheumatic disease, arthritis, and other disorders of the joints, muscles, and ligaments while orthopedics focuses on the study of the musculoskeletal system and the correction of deformities of bones or muscles. A rheumatologist is a board-certified internist or pediatrician who is qualified by additional training and experience in the study of rheumatology. An orthopedist is a medical doctor who specializes in diagnosing and treating musculoskeletal conditions. In your case, it would be more appropriate to see an orthopedist about osteoarthritis of the knee and knee replacement options. If you wish to receive any care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  28. Hello, I’ve been diagnosed as having Sarcoidosis in my lungs and in the past six months or so, I’ve noticed white circular spots on my forearms and upper chest area. Is it possible that these spots are a result of the Sarcoidosis and if so, is there any way they can be removed as not to be so noticeable? Thank you

    1. Hi Doug, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Hard to tell without actually seeing the spots. Sarcoidosis can affect the skin. When it does, it causes soft little lumps (less than half an inch/1 centimeter), sort of like warts. Another reason for white circular spots (a few inches/5 centimeters) across would be vitiligo, which is a different autoimmune disease, or a fungus infection. Dark-skinned people sometimes develop very small light spots (1/8 inch, 1-2 millimeters), which mean very little. A dermatologist who sees what you are talking about could tell you more.”

  29. recently i have been having burning in my feet. it will appear in my shins and maybe later above my knees. my feet get real cold when burning goes away then repeats. also have tinging in feet. same is true in my hands. can a rheumatologist help? my neurologist is referring me to one because of elevated CRT levels.

    1. Hi Jim, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It depends on what else is going on. For example, how old you are and if you have any other nerve problems. High CRP levels mean inflammation, so that is probably the reason for the referral. It sounds like nerve injury is the concern (peripheral neuropathy), which can be caused by some rheumatic diseases. More often, however, it is due to something else.” If you wish to receive a consultation at Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  30. hello, i am not sure if I should see a neurologist or rheumatologist. my symptoms include joint pain and achiness in the hands, wrists, arms, legs, feet, ankles. for years I have had neck pain and now even the tailbone is sometimes uncomfortable. numbness and tingling in both hands but usually occurs while sleeping although I have one fingertip that is slightly numb right now. reoccurring vibration in feet, almost like a very mild electrical charge. this feeling comes and goes. it may be noticeable for a month or so, and then may not happen for months. i did have an MRI about 4 years ago to rule out MS and all was well but a microadenoma was found on the pituitary, so i return for follow up MRI’s (of course that’s just concentrating on that area of the brain)

    my primary, who is brand new to me, gave me a referrel to see a neurologist for parathesia of the hand. so maybe there is some carpal tunnel, but I feel that she just overlooked all the other info I was giving her upon my regular checkup (1st time with her).

    any input would be appreciated!

    1. Hi Karen, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Those types of nerve problems could be caused by arthritis or they could occur independently. Since you mention joint pains and carpal tunnel, a rheumatologist is more likely to look at all of the areas. The microadenoma is probably unrelated. It is a fairly common and usually not too important abnormality. However, if it is secreting hormones, especially growth hormones, it could cause your problems. The endocrinologist or neurologist will have done tests about the hormones, I assume.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  31. My son was diagnosed with dyshidrotic eczema by a dermatologist. He suggested my son see a rheumatologist. Is that something a rheumatologistn treats. I have researched it but can’t seem to find the relationship. I would appreciate your assistance. Thank you.

    1. Hi Pua, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “Eczema (all types) is usually handled by a dermatologist. It has nothing to do with rheumatology, unless there is a question about the diagnosis, or the name is wrong. It would be best to consult with your son’s dermatologist for clarification.”

  32. I just saw my General Practitioner and he said I have arthritis in the spine and hip, but he does not believe I should see a rheumatologist. Instead he is sending me to a pain management doctor. I am a female, 43 years old and have had chronic back pain for over 20 years. It is progressively getting worse. Some mornings I can barely walk due to the pain and stiffness. I am just wondering if a rheumatologist will be more effective at treating my back and hip pain?

    1. Hi Christina, thank you for reaching out. Dr. Michael Lockshin,Rheumatologist,says: “You are very young to have such problems and, of course, arthritis is something Rheumatologist deal with. A Rheumatologist may end up sending you for pain management but might also find something that can be dealt with in a different way, so, yes, I recommend getting a rheumatology opinion.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  33. Hi I have a level L5 herniated disc and C3 cervical disc my severe joint pain in my legs and my pain management is not helping any suggestions?

    1. Hi Kimmey, thank you for reaching out. Dr. Darren Lebl, Orthopedic Spine Surgeon, says: “While many disc herniations can improve with time, this is not always the case. In particular, if a nerve is being severely compromised there is risk of permanent neurological deficit. A high quality MRI scan should be reviewed by a spine specialist if the pain in the legs and arms have not been improving. Depending on when the initial MRI was performed, a more recent interval MRI scan may be worthwhile to evaluate any potential reabsorption of the disc herniation and potential consideration for surgical intervention. If any dense areas of numbness, weakness, bowel or bladder incontinence, then the disc herniation should be evaluated by a spinal surgeon right away.? If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  34. Hi I have had on and off trouble with my hand feet hips and knees hurting and swelling. Since 09 I had one positive test for lupus in 09 then the rheumatologist never contacted me back. A couple mounts ago started having my hair fall out in a wad straight from the root, I have red rash on my face. and feeling extremely tired a lot. My family doctor did more blood work and it came back positive for ANA, DSDNA, SSA,and SSB antibodies. Does this mean I have lupus? Will the rheumatologist do their own blood work? Also why did my doctor think I had it back in 09 but rheumatologist didn’t?

    1. Hi Christi, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “If all those antibodies are positive, yes, it is the case that you have lupus. Whether your rheumatologist will repeat the laboratory tests will depend on how much he/she trusts the laboratory tests that you already have. If the tests are recent and from a laboratory that can be trusted, they don’t need to be repeated to make treatment decisions.”

  35. I have a major concern. I have seen two podiatrist due to pain and swelling in my left ankle,pain on top of foot and bottom of foot. I work 12 hours at a hospital after 5hours into my shift the pain is hurting so bad. I have had compound pain creams that doesnt work. I wear ankle brace that does not help. Tramadol is not touching my pain of 10 plus would it be better for me to see a Rheumatologist. I was told that I have arthritis and neuropathy

    1. Hi Clarissa, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: ?Yes, a rheumatologist should be able to help you. If you have arthritis and neuropathy it may be that an orthopedist and/or a neurologist could help as well.? If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  36. I have been diagnosed with very bad arthritis in my left knee. Had a torn meniscus years ago and the pain is awful now. It travels from the knee to my toes and the back of my knee and leg. Is it time to see a Rheumatologist? There are days I can only walk a few feet and thats it. Can’t bend the leg or anything. Its terrible. Any information is appreciated. Thank you!

    1. Hi Michelle, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: ?It?s not actually a lupus problem that you are talking about, but it is something that a rheumatologist (or an orthopedist) can help you with, so, yes, it is time.? If you wish to seek consultation at Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  37. Hi, I’ve been having lower back pain for almost a year now. I have been treated by physio therapists, osteopath, chiropractor, myotherapist and acupuncturist unsuccessfully. It started out as a tingling pain or burning sensation at the lower back area. I could walk, stand, bend backward or forward no problems, no pain down the legs. Mainly to do with sitting, I can’t sit longer than 15 mins without the feeling that the pain is coming. Some nights I can’t lie on my back without pain, pillows below the knees doesn’t help as the burning sensation feeling is there when a friction with a mattress occurs. If I apply ice, then it settles down however next morning it aches a lot. It eases a bit when I sit slump like a C shape.

    I am an active person, I don’t sit longer than 15 or 20 mins at a time, I walk a lot, I do social swimming a few times a week.

    X-Rays and RMI came back with nothing. Blood tests for HLA, or other type of arthritis come back with negative, no inflammation in blood was found.

    Is there anything you can please advise ?

    Thank you so much.

    1. Hi Thinh, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It’s not really a lupus problem that you are talking about, but it is something that a rheumatologist (or an orthopedist) can help you with. A thoughtful rheumatologist or orthopedist may be able to review all of your x-rays and MRIs, and examine you, to suggest a solution.” If you wish to seek consultation at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  38. I have been having symptoms of soreness in my hands , fingers and just recently started in my feet , toes and ankles. By the end of the day I can barely walk they hurt so bad. When I’m at home they also hurt without my shoes on. Does this sound like it might me rheumatoid arthritis? My family Dr has put a referral in for a rheumatologist. RA run both on my mom and dad’s side of the family. I started get symptoms of soreness in my hands back in 2013 my Dr tested me for the rheumatoid factor but it came back negative. The soreness came back in September of 2014 and again when I went to my doctor a second time about the soreness in my hands he tested me a second time for the rheumatoid factor and again it came back negative he also did x-rays the second time and they showed nothing. When the symptoms came back a third in I started feeling it not just in my hands but in my feet on the top of them and on the bottom as well and through my toes. I wake up with the soreness every morning and it seems to stay there through out the duration of each day. My daily activities my it worse . My question is could it be that rheumatoid arthritis is starting to form or is it another for of arthritis? Also should I go on and see a rheumatologist about this too?

    1. Hi Jason, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It does sound as if you are developing some type of arthritis. It could be rheumatoid- you don’t need to have a positive blood test to make this diagnosis- or something else. A rheumatolgoist should be able to sort this out.” If you wish to seek care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  39. Hi, I have Raynaud’s and my orthopedic doctor won’t do surgery on the base of my right thumb until I get a clearance from a rheumatologist, why is that?

    1. Hi, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “I can’t think of a good reason, except maybe the orthopedist wants to be sure there isn’t a systemic rheumatic illness present that would complicate surgery. However, there aren’t many reasons related to systemic rheumatic illnesses that would make a difference at the base of the thumb.”

  40. Thank you for all the comments on here. I have been having trouble with my wrists and ankles for some time and I also suffer from Panic attacks and Generalized Anxiety Disorder so I try to ignore all my issues so I don’t look like a hypochondriac but I can put it off any longer. I am at the point I can hardly use a manual can opener or get my daughter out of her car seat. I guess I will be on the search for a rheumatologist. Thanks again.

    1. Hi Renea, thank you for reaching out. We’re sorry to hear about your situation. If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  41. My daughter is 13 years old and has been a softball players since 5 years old. She is already being scouted by colleges but the past 7 months she has had severe back pain all over and hasn’t been able to play? We’ve had an MRI and bloodwork and nobody can find anything wrong? It’s very frustrating and I hate seeing her in this pain. It gets hurting so bad it takes her breath away. Do you think she would benefit from seeing a rheumatologist? I just don”t know what else to do and there has to be something wrong for her to be in such pain for so long!! Please help and advise.
    Thank you.

    1. Hi Jennifer, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It is certainly unusual for a 13 year old to have severe back pain. Yes, i do think that it would be useful for her to see a rheumatologist.” If you wish to seek consultation for your daughter at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  42. Hello Dr., While pregnant (over two years ago) I was diagnosed with preeclampsia… Further investigation and testing from the doctors lead to a diagnosis of ITP, antiphospholipid antibody syndrome (APS) and I was suspected of having lupus (due to positive ANA, lupus anticoagulant and anticardiolipin antibodies etc). Now that I have better insurance I”m going to a rheumatologist locally with my first appointment next month, but I”m not sure what to ask for my first visit. I am having awful joint pain and swelling in my hands (including wrists and fingers), feet, right hip and shoulders (daily), with chronic migraines happening every other day. Are there specific questions I should be asking at this appointment to ensure the correct diagnosis? Also, are there specific blood tests I should be requesting? Also, I have kept a detailed diary of all my symptoms for the past 6 months.

    1. Hi Siera, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “You should tell the doctor all you have just asked and ask for these tests as the doctor should know this already. Many can be repeated since it has been two years, including CBC, chemistry profile, urinalysis, ANA, Anti-DNA, Anti-Smith/RNP, Anti-Ro/SSA and Anti-La/SSB, anticardiolipin, lupus anticoagulant, and ESR. Good luck to you.” It is best for you to seek consultation with a physician to determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  43. Dr. Alana B. Levine is a specialist with Sjogren”s syndrome. I am a 62 year old male in good health but dry eyes (takes restasis drops) dry mouth, and has joint pain.. I understand 9 out of 10 people with Sjogren”s are women. I might possibly have the condition. Does Dr. Levine see male patients?

    1. Hi Ken, thank you for reaching out. Yes, Dr. Levine does see male patients. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  44. Hi, doctor!
    I was diagnosed with Hashimoto’s about a year ago. Recently i started developing pain in my right elbow and the MRI proved I had lateral epicondylitis and exterior tendinosis. I do use my right arm extensively at work, but now I have the same symptoms on my left arm around the same area as on the right. I was wondering if Im developing one of those rheumatoid diseases in connection with my thyroid condition? Will you be able to diagnose me?
    Thank you in advance!

    1. Hi Laura, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “It is not unusual for people with Hashimoto’s thyroiditis to develop other symptoms of arthritis, sometimes indicating a second illness and sometimes just due to changing thyroid function. However, the MRI report that you give suggests overuse. If you don’t use your left arm as extensively as you use your right, then there is a reason to wonder whether the MRI was read correctly. It is probably worth reviewing that with your doctor, since I would not expect both the right and the left arm to be involved with overuse.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  45. Hello, I am scheduled to see Dr. Levine. I am so scared…i don”t know what to expect, I have been sick for so long. I am terrified. Do you offer support services at HSS?

    I think from what I see Dr. Levine is a compassionate doctor. I am praying she can help me.

    1. Hi Colleen, thank you for reaching out. Emily Reiss, Rheumatology Social Worker, says: ?Cultivating a relationship with a new doctor can be frightening. At HSS, Social Work Services are available through the Department of Social Work Programs. Social workers like myself meet with patients regarding concerns about the impact of illness and treatment options, provide emotional support and assist with accessing resources. There are also a number of disease-specific support and education programs available to meet the needs of our patients and their families through the Social Work Programs Department. For more information, you can go to our website:

  46. Hi doctor,

    I have been suffering from vasculitis from past 7 years. I am under Ayurvedic treatment, although it works very slow but effective. My size and frequency of the wounds have reduced since then but i still do get them on my ankle sometimes. I a lot of restrictions on the diet have helped me throughout. Doctor says there is no fixed cause for this and it should go on its own, I want to know more on this condition. Its has been told that its is because of autoimmune.

  47. I am just a regular person who suffers from arthritis/arthritic due to injuries & past surgeries. I have Local 1199 as my medical insurance carrier. I desperately need to locate a Rheumatologist who can assist me immediately with my daily medical problems.

    Can someone point me in the right direction
    I need help now.

    Thank you.

    1. Hi Larry, thank you for reaching out. Mavis Seehaus, Social Worker, says: “The best course of action would be to contact your 1199 insurance plan to find out rheumatologists that are in your network. You might also check to see if you have out-of-network benefits that would allow you to see a rheumatologist here at HSS, if you would like to.” If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

  48. I have osteoarthritis in multiple joints and have had meniscus surgery twice in each knee, implant in right 4th finger, carpal tunnel surgery, trigger finger surgery, cervical C3-C5 implant and soon to have thumb surgery with another carpal tunnel surgery. My rheumatologist has nothing to offer because medication does not work for me nor has cortisone treatments. Any ideas?

    1. Hi Jeanette, thank you for reaching out. Dr. Lisa Vasanth, Rheumatologist, says: ?Current non-operative treatment for osteoarthritis aims to improve pain and function. Management generally includes a combination of approaches: low impact exercise, weight reduction if indicated, physical and occupational therapy, assistive devices such as canes or braces, pain management with analgesics (Tylenol or tramadol) or non-steroidal anti-inflammatory drugs (topical or oral), and injections with intra-articular glucocorticoids or hyaluronans. For those who do not respond or who are unable to take standard treatments, there are second line medications for pain management including serotonin-norepinephrine reuptake inhibitors like duloxetine and milnaciprin. There are also experimental biologic agents and intra-articular therapies for pain management, which are best discussed with your rheumatologist. To date, there are no licensed medications for osteoarthritis which inhibit structural disease progression. However, there are many prospective agents under investigation.? If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

  49. Do I need a referral from my primary care physican to be able to see a rheumatologist? I have been diagnosed with arthritis and fibromyalgia by my regular physician, but would I benefit from seeing a rheumatologist?

    1. Hi Sarah, thank you for reaching out. To find out if you need a referral, it is best to check with your insurance provider and their guidelines. To learn more about referring to a rheumatologist, please visit If you wish to receive care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

  50. My sister was diagnosed with Rheumatoid Arthritis (had positive RA factor and value in three digits).She had developed a skin deep ulcer on her feet between ankle and knee.Even skin grafting operation failed. The ulcer was skin deep but spreading and some fluid oozed out. She eventually died. Was it due to Rheumatoid Arthritis?

    1. Hello, thank you for reaching out. Dr. Susan Goodman, Rheumatologist, says: “Rheumatoid Arthritis is a systemic disease, and rare patients with RA may develop skin ulcers due to vasculitis. Vasculitis can be a very serious condition in which the blood vessels become inflamed. Blood vessels provide nourishment and oxygen to all parts of the body, and inflammation may cause them to become blocked, leading to death of tissues fed by those blood vessels. This may lead to skin ulcers when the small blood vessels to the skin are affected, but internal organs may be similarly affected, leading to heart or kidney damage. Patients at risk for Rheumatoid Vasculitis typically have extremely high RA factor levels, although in the vast majority of patients, a high level only signifies worse joint disease, and may even occur in patients who do not have RA. Vasculitis is the most life threatening complication of RA. While many people think of RA as a joint-only disease like osteoarthritis, the entire body can be affected, and sadly, severe cases can be life threatening. It is certainly possible that your sister died of this rare form of RA.”

  51. Very informative Dr. Alana. Many types of rheumatic diseases are not easily seen at an early ages, but a rheumatologists are specially experienced to do the work needed to determine the root of swelling and pain. It?s essential to know the correct diagnosis early so that right treatment can start early because some disorders respond best to treatment in the early stages of the disease. So it”s always important to put an effort into getting the right doctor, but if a patient can”t find rheumatologist at all, looking for a primary care doctor who treats many RA patients may also be possible.

  52. I have an appt there on Jan 8 th with Dr Ashany.. I hope to get a diagnosis and some answers to my Medical problems. Why is it so hard to get a diagnosis?

    1. Hi Samantha, thank you for reaching out. Dr. Alana Levine, Rheumatologist, says: “Some medical problems can be extremely difficult to diagnose. Rheumatologists, in particular, diagnose and treat a variety of diseases, some of which are extremely rare. Because they are so uncommon, it can be challenging for primary care or family doctors- or even rheumatologists- to diagnose them right away. In addition, the symptoms of rheumatic diseases can be vague, especially at the beginning of the illness. This can make it hard to figure out the cause of the symptoms. Dr. Ashany is an excellent physician.” Let us know if you need further assistance.

    1. Hi Joann, thank you for reaching out. Please contact our Physician Referral Service at 877-606-1555 for further assistance.

If you’d like to consider HSS for treatment, please contact our Patient Referral Service at 888-720-1982. For general questions and comments, reach us on Facebook or Twitter.