Your first rheumatology appointment

A few simple things help make the most of your appointment:

• Note when your symptoms started, which areas are affected, and what makes them better or worse
• Bring a list of any medications and supplements you take
• Bring any relevant letters, blood tests or scan results if you have them
• Note any family history of arthritis or autoimmune conditions
• Wear clothing that allows the affected areas to be examined comfortably

You are very welcome to bring a partner, relative, friend or carer to your appointment. Many people find it reassuring to have someone there, and a second pair of ears can help you remember what was discussed and take part in decisions.

If you would find it easier to have an interpreter, or if you have any access needs, it helps to mention this to the practice when you book so the visit can be arranged smoothly. There is no need to fast or stop your usual medication for the consultation itself unless you are specifically advised to. If blood tests are arranged on the day, you will be told whether anything needs to be done to prepare for them. It is also fine to make a few notes during the appointment, or to ask for anything to be repeated or explained again.

Dr Borukhson will take a careful history, listening to the full story of your symptoms, and then examine the relevant joints and areas. The aim is to understand not just the affected joint, but the wider picture, since rheumatic conditions can affect more than the joints alone.

A distinctive feature of the consultation is the use of point-of-care ultrasound. This means relevant joints or tendons can often be examined with ultrasound there and then, which can clarify the diagnosis and, where appropriate, allow an ultrasound-guided injection within the same visit. You can read more on the ultrasound clinic page.

It is natural to wonder whether any of this will be uncomfortable. For most people the appointment is straightforward and not painful.

• The physical examination involves looking at and gently moving the affected joints to see how they bend, where they are tender, and whether there is any swelling or warmth. You may be asked to do a few simple movements. Tell Dr Borukhson if anything is sore, as the examination can always be adjusted.
• The ultrasound uses sound waves, not X-rays, so there is no radiation. A little gel is applied to the skin and a small probe is moved over the area. It is painless, and nothing is injected for the scan itself.
• If an injection is appropriate and you agree to it, a local anaesthetic is usually included, so most people feel pressure rather than sharp pain and the procedure is generally well tolerated. You can read more about how these are done on the ultrasound-guided injections and steroid injections: when they help pages.

You will only ever be asked to undress as far as is needed to examine the relevant area, and your privacy and comfort come first. You are welcome to ask questions at any point, and to pause if you need to.

By the end of the appointment, the aim is for you to understand what is going on, what any further tests are for, and what the plan is. If investigations are needed, these will be explained and arranged, and the next steps and follow-up agreed with you.

Clear communication with you, and where appropriate with your GP, is an important part of joined-up care.

Private appointments are arranged through the practice. Dr Borukhson is fee assured with the insurers she works with, and self-pay fees are set out on the fees page. If you are using insurance, it is worth obtaining a pre-authorisation code from your insurer beforehand.

How long does a first rheumatology appointment take?

A first appointment is unhurried and usually allows enough time to hear the full story of your symptoms, examine the relevant areas, and agree a plan. It tends to be longer than a routine GP visit. Because Dr Borukhson uses point-of-care ultrasound during the consultation, relevant joints or tendons can often be looked at in the same visit, which can save you a separate scan appointment later.

Do I need a GP referral to see a private rheumatologist?

You can usually book a private appointment directly through the practice. That said, a referral letter from your GP is genuinely helpful, as it shares background, examination findings and any results already to hand. If you are using private medical insurance, your insurer will typically ask for a GP referral and a pre-authorisation code before your appointment, so it is worth checking their requirements early.

What should I bring to my first appointment?

A few simple things help. Bring a list of your medications and supplements, and any relevant letters, blood test results or scan reports you have. It also helps to note when your symptoms started, which areas are affected, what eases or worsens them, and any family history of arthritis or autoimmune conditions. Wearing clothing that lets the affected areas be examined comfortably makes the examination easier.

Will I get a diagnosis and tests on the day?

The aim by the end of the visit is for you to understand what is going on and what the plan is. Sometimes the picture is clear straight away, helped by ultrasound during the consultation. In other cases, blood tests or further imaging are arranged, and these are explained so you know what each is for. Where appropriate, results and next steps are also shared with your GP.

What happens after my first appointment?

Any further tests are arranged and the follow-up agreed with you, so you leave knowing the next steps rather than being left with unanswered questions. If a diagnosis is confirmed, treatment can often begin, and where suitable an ultrasound-guided injection may be possible within the same visit. Clear communication with you, and where appropriate your GP, keeps your care joined up between appointments.