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Old 08-17-2020, 10:34 PM
 
Location: Denver 'burbs
24,012 posts, read 28,399,744 times
Reputation: 41122

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Quote:
Originally Posted by mike1003 View Post
I've got over 50 year medical and pharmaceutical training. MrsM has the same. I know which Drs to go to and my PCP agrees with us 100%


Next?
But we're not talking about you, we're talking about the OP.
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Old 08-17-2020, 11:09 PM
 
Location: Illinois USA
1,267 posts, read 826,400 times
Reputation: 946
Quote:
Originally Posted by maciesmom View Post
Go to your PCP and after a physical, he or she will most likely ask for a blood panel which includes CRP and ANA. Depending on the results they may refer you to a rheumatologist.
CRP/ESR
ANA
RF
anti-CCP
uric acid

a lot of PCP can start and manage the older gen DMARDs , newer ones rheum
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Old 08-18-2020, 05:47 AM
 
Location: NJ
23,838 posts, read 33,397,843 times
Reputation: 30707
Quote:
Originally Posted by mike1003 View Post
Our Medicare Part B and supplemental insurance (AARP, United Healthcare) does not require a referral so we always skip our PCP and go directly to specialists
Me too even though I have a medigap with no copays. My time is valuable plus I'm disabled. I don't have time or the back to go to multiple doctors.

Quote:
Originally Posted by qzaa3 View Post
I been having some issues with my joints in my knees, elbows, and fingers. Also, weakness in my bones and muscle ache. I'm thinking this could be some kind of arthritis or other autoimmune disease. Based on my research. Although, I'm not 100% sure. It's been progressing, started in my knees, then my elbows, and fingers, and becoming more severe.

I would think the doctor would check out my body parts, blood test and x-rays based on my research.
Would an Internist be able to make a diagnose based on these test?

Or should I go straight to the rheumatologist?

If you don't need a referral to a rheumatologist I'd start there. Why waste a copay with the GP unless the rheumatologist can't get you in for months.

My daughter, grandson and I have an autoimmune disease called a connective tissue disorder that attacks the joints. You can look up Ehlors Danlos syndrome. I have a PDF I can email you called "so you think you have EDS?" It used to be online but hasn't been in years. It details the various associated disorders.

My daughter went to a rheumatologist and got diagnosed. I have not been but I know I have it because I've always been double jointed. I can bend my thumb behind my hand and touch my head from my back. There are a bunch of other things that go along with it, one of them is bad teeth that no matter what you do, they break off at the gum line.

My daughter was always what I'd call a klutz. She could fall walking up stairs. Turns out that it's due to her eyes being bad due to pressure from spinal fluid. Her eye doctors over the years had told me there was nothing wrong with her eyes until the last few years with newer testing.
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Old 08-18-2020, 12:55 PM
 
17,424 posts, read 13,200,337 times
Reputation: 32784
Quote:
Originally Posted by maciesmom View Post
But we're not talking about you, we're talking about the OP.

If OP's insurance doesn't require referrals, it is a waste of time and money to see a PCP for a referral. PCPs are (IMHO) only for yearly check-ups and minor illnesses
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Old 08-18-2020, 01:16 PM
 
Location: prescott az
6,954 posts, read 12,023,860 times
Reputation: 14219
I was diagnosed at the Urgent Care here with RA. The blood tests (Anti AAA, CRP, and RA) showed the diagnosis clearly. It's not rocket science. Once you have confirmation, then see the rheumatologist, if you can find one with openings.
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Old 08-27-2020, 09:02 AM
 
76 posts, read 90,165 times
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I don't need a referral to see a specialist, but the copay is more. I'm just afraid the internist can't really confirm a RA diagnosis and just then sends me to a rheumatologist.

I guess the question is, is it common for an internist to do the blood test, look at my affected joints, do x-ray.
Confirms is RA and prescribed DMARD drugs to treat it?
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Old 08-27-2020, 10:40 AM
 
9,952 posts, read 6,625,076 times
Reputation: 19656
Quote:
Originally Posted by qzaa3 View Post
I don't need a referral to see a specialist, but the copay is more. I'm just afraid the internist can't really confirm a RA diagnosis and just then sends me to a rheumatologist.

I guess the question is, is it common for an internist to do the blood test, look at my affected joints, do x-ray.
Confirms is RA and prescribed DMARD drugs to treat it?
Internists can order labs/imaging and then make the referral for you to the rheumatologist if the labs indicate that you have arthritis or some other condition that a rheumatologist could great. Keep in mind that there are some reasons why you might have joint problems that could be unrelated to something a rheumatologist could treat, and then you’d have to go back to the PCP anyway.
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Old 08-27-2020, 12:26 PM
 
Location: on the wind
23,074 posts, read 18,469,364 times
Reputation: 74671
Quote:
Originally Posted by RamenAddict View Post
Keep in mind that there are some reasons why you might have joint problems that could be unrelated to something a rheumatologist could treat, and then you’d have to go back to the PCP anyway.
This was my thought too. Symptoms described were vague.
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Old 08-27-2020, 01:10 PM
 
5,644 posts, read 13,201,288 times
Reputation: 14170
Quote:
Originally Posted by AZgarden View Post
I was diagnosed at the Urgent Care here with RA. The blood tests (Anti AAA, CRP, and RA) showed the diagnosis clearly. It's not rocket science. Once you have confirmation, then see the rheumatologist, if you can find one with openings.
It isn't completely cookbook as you infer either.

Up to 40% of patients who have Rheumatoid Arthritis are seronegative....labs are normal and the diagnosis is made solely by history and physical exam...which is where the Rheumatologist comes in.

There are also a host of other autoimmune and immunologic conditions that can present with forms of arthritis.

If it's me I would start with the PCP first...usually lower copay anyway. If your PCP thinks based on labs, history, exam, gestalt that you might have a Rheumatologic condition they are going to want to refer you on...

There are a host of things that can cause joint pains and myalgias as described in the OP from tickborne diseases to dermatologic issues, infectious diseases, GI issues....on and on..

Better to take the big picture view to start.
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Old 08-27-2020, 05:14 PM
 
9,952 posts, read 6,625,076 times
Reputation: 19656
Quote:
Originally Posted by bluedevilz View Post
It isn't completely cookbook as you infer either.

Up to 40% of patients who have Rheumatoid Arthritis are seronegative....labs are normal and the diagnosis is made solely by history and physical exam...which is where the Rheumatologist comes in.

There are also a host of other autoimmune and immunologic conditions that can present with forms of arthritis.

If it's me I would start with the PCP first...usually lower copay anyway. If your PCP thinks based on labs, history, exam, gestalt that you might have a Rheumatologic condition they are going to want to refer you on...

There are a host of things that can cause joint pains and myalgias as described in the OP from tickborne diseases to dermatologic issues, infectious diseases, GI issues....on and on..

Better to take the big picture view to start.
Right and sometimes the answers can be as simple as a medication side effect- either due to too high a dose, a medication interaction, or simply not being able to tolerate the medication. I remember going into the PCP last year thinking something was horribly wrong with me because I’d suddenly developed awful insomnia combined with drenching night sweats and she knew instantly that it was a new medication I’d started. Once I stopped that and the medication left my system, the problem resolved.
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