Should You See a Rheumatologist If You Have Psoriasis?
You may already have a dermatologist on your care team for your psoriasis, but have you considered adding a rheumatologist to your list of specialists?
A rheumatologist is a doctor who can diagnose and treat arthritis, other conditions that affect the joints, bones, and muscles, and autoimmune diseases. This kind of doctor may not seem like an obvious choice when you have a skin condition like psoriasis, but about one-third of people with psoriasis also go on to develop psoriatic arthritis. This type of inflammatory arthritis can lead to pain and swelling in the joints, and prompt treatment can help you avoid joint damage.
When to See a Rheumatologist
According to Lynn Ludmer, M.D., a board-certified rheumatologist at Mercy Medical Center in Baltimore, a rheumatologist can be helpful especially if you develop any symptoms that may point to psoriatic arthritis. These include:
- Tenderness, pain, or swelling over tendons or one or more joints
- Sausage-like swelling of the fingers or toes
- Morning stiffness in the joints
- New, chronic low back pain associated with significant morning stiffness and that wakes you up in the middle of the night or improves with exercise
- Reduced range of motion
- Nail changes
Your dermatologist may screen for these symptoms, as well, and can refer you to a rheumatologist if they think it’d help you.
What Happens When You Go to a Rheumatologist?
A rheumatologist can help by evaluating your symptoms and whether or not they’re psoriatic arthritis or another condition. They can also guide you in your treatment and help you make adjustments along the way.
Examination and Diagnosis
When you visit, the doctor will want to know your personal and family medical history, whether you smoke or drink, and all the medications that you take.
In this way, a rheumatology exam is similar to the type you would have at a routine physical, Ludmer says. However, the rheumatologist will also pay special attention to your skin and nails, as nail changes such as pitting or separation from the nailbed are one of the symptoms of psoriatic arthritis. Another symptom your rheumatologist may look for is swollen fingers and toes that can look like sausages. If you have back pain, they may take specific measurements to measure how different parts of the spine move.
A rheumatologist will likely try to get a detailed description of your symptoms. They will generally try to figure out when symptoms started, whether there were clear triggers for the pain, and the pattern of the pain.
Your rheumatologist will also likely want to see results of any previous screenings you’ve had, such as X-rays and bloodwork. “There are many types of arthritis, and not all patients with psoriasis and joint pain have psoriatic arthritis,” Ludmer says. Osteoarthritis and fibromyalgia can have similar symptoms to psoriatic arthritis, says Alexis Ogdie-Beatty, M.D., a board-certified rheumatologist at the University of Pennsylvania’s Penn Medicine. A rheumatologist is skilled at telling conditions like those apart.
Expect your rheumatologist to help educate you about your disease and help you find the best treatment for your condition, says Lawrence Brent, M.D., a board-certified rheumatologist at Temple University Hospital in Philadelphia.
Several medications are available to help treat psoriatic arthritis, and a rheumatologist can help you decide on the best one to start with. Psoriatic arthritis is often accompanied by other medical conditions such as obesity, high blood pressure, diabetes, and heart disease, Ludmer says. “A rheumatologist is trained to take these conditions into account when prescribing medication to treat psoriatic arthritis,” she says.
Often, the ideal approach to treatment for people with psoriasis and psoriatic arthritis involves cooperation between your dermatologist and rheumatologist. Together, they can help find a regimen that addresses both skin symptoms and joint symptoms in a way that fits best with your lifestyle.
If you have psoriatic arthritis, how often you will need to see the rheumatologist will depend on your condition and how you respond to treatment, Brent says. “Every patient is different,” he says. “Early after the diagnosis and institution of treatment, patients may be returning every one to two months. Patients who are very stable without active disease on stable medications may be seen every six months depending on the treatments.”
Talk to your doctor to find out how often you should be meeting. They can help decide how well treatment is working and make adjustments to your treatment plan as needed.
How to Find a Rheumatologist
If you think a rheumatologist may be able to help you, begin with asking your primary care doctor or your dermatologist to recommend a local rheumatologist, Brent suggests.
Ludmer notes you can also search the provider directory from the Arthritis Foundation for rheumatologists in your area. The American College of Rheumatology also has a provider directory you can search.
Most board-certified rheumatologists have some experience with treating psoriatic arthritis, Ogdie-Beatty says, and you should find one who does. However, it’s even more important that you find your visits helpful and that you’re getting results from the treatment your rheumatologist has prescribed. If you’re not seeing a difference after giving it the time you’ve discussed with your doctor, she says, you may want to look for someone else. When you find the right rheumatologist, they’ll be a valuable resource in helping you feel your best.
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