Tips For Your Next Rheumatologist Appointment - Straight From A Rheumatologist!

Rheumatology appointments for psoriatic arthritis (PsA) can be very stressful. Not all rheumatologists seem to understand the true impact of PsA on life, which makes it hard for people to get the proper care. We asked Dr. Donica Baker, a board-certified rheumatologist, to share her insights as a doctor on healthcare professional and patient relationships and tips to make the most of an appointment!

How can patients improve their relationship with their doctors?

Treatment and healthcare frustrations are not uncommon within the psoriatic arthritis community. Do you have any advice for improving relationships with healthcare professionals?

"Yes, I think there's a lot of healthcare frustrations. I’ve reflected on this a lot, and I think it's because a lot of people who are in the medical field tend to have been from healthy backgrounds and healthy families… So, to be honest, I don't think a lot of doctors really understand what it's like to be on the other side of the table where you're really sick and you have to depend on other people to help you make the decisions and get your labs down all the time and take all these medicines. I don't think that's really understood."

How did you see what it was like to be on the other side?

What changed your perspective on the HCP and patient relationship?

"For me, that light bulb went off when my son was really sick in the hospital and then me and my husband were in the ICU with him. So that almost helped me in a way. I was able to see what it was like from the other perspective, as a family member, and see that, wow, it's really tough talking to all these doctors that are coming in and being on the other side of things.

So I think in a way, it made me more open-minded to people going through an illness and just listen. I try to see things from their perspective and I feel like everyone's perspective on treatment is so different. Not everyone wants to be pushed into methotrexate or biologics. Some people would rather take as little medications as possible. I've had other patients tell me that their previous dermatologist was mad at them because of certain things because they didn't want to try this medication or they didn't do this. It kind of was a barrier in the relationship. So I try to ask and see what their personal take on medications is and what their personal belief system about treatment is. I think that really helps.

I believe in shared decision-making with patients. So I go through the options with them and what the pluses and minuses of each treatment might be. Then we make the decision together rather than just telling them, take this, if you don't take this, something terrible is going to happen to you. I try to give them the options and tell them all the information, but in the end, I let them be their own decision maker."

How do you know what treatments to recommend?

How do rheumatologists learn about treatment options? What type of factors do they consider when making a recommendation?

"With learning about treatment options, it seems like there are so many new treatments and biologics coming out in articles and publications in the rheumatology journals. So reading those journals and reports really helps as well as understanding what new side effects or risk factors come with each.

When making a recommendation for someone, I consider the factors of a patient's other conditions or comorbidities. For example, a lot of the TNF inhibitors like Humira and the other ones have some black box warnings. So if a patient had a history of lymphoma, obviously I would avoid one of those, and another treatment might be much safer. Or if a patient has some history of liver problems, obviously avoid methotrexate and some of the medications that could affect the liver even more. So I consider their health conditions other than psoriasis to see whether these medications will be safe.

Then I ask about personal preference too because some patients prefer oral tablets, as they're really scared of needles and injections. Whereas some patients really don't mind the injectables and would rather take an injection once a month and rather than have to remember to take a pill every day. So I take their personal preference into account too."

How can patients come prepared to their rheumatologist appointment?

What are the top 3 things people should come prepared with for their next rheumatologist appointment?

"First is any major flares that they have experienced since the last appointment and where those flares may have occurred. So, for example, some people are really stable and haven't had any major episodes since the last appointment, whereas other people may have had 2 or 3 flares of finger swelling or pain in their back or toes. So make a note of how many flares have occurred, how severe those flares have been, and where those flares have been occurring.

The second thing would be any side effects that they've experienced from their treatments. Some people have not experienced any side effects at all and the medicines have been tolerated pretty smoothly. Other times, some may have experienced some stomach upset from their treatment or injection site reactions from an injection they took with hives. So make a note and let your rheumatologist know about any side effects or adverse effects from medications.

The third thing would be any improvements that they've felt, whether they feel like their medicines and treatments are working or not helping, or whether they feel just about the same as they did at the last appointment, and whether those improvements or flares have been influenced or triggered by anything. Some say that the weather really triggers their flare. They can definitely feel when a storm is coming, or they have actually pinpointed certain dietary things like gluten or sugar that have really flared up and they say once I cut out the gluten, I noticed a really significant improvement. So if you're able to make any correlation between any of those things to see whether you felt better or worse, basically."

Looking for more insight from Dr. Baker?

Working with a rheumatologist for psoriatic arthritis isn’t always easy. But we hope Dr. Baker’s answers can reveal some more information on a rheumatologist’s perspective to make your next appointment a bit more helpful. More information from Dr. Baker can be found in her author archive.