What a rheumatologist evaluates
A rheumatologist specialises in autoimmune and inflammatory diseases affecting the joints, muscles, bones and connective tissue. At this clinic the most common referrals are joint pain and swelling (rheumatoid arthritis, psoriatic arthritis, gout), chronic inflammatory back pain (ankylosing spondylitis, spondyloarthritis), multi-system autoimmune symptoms (lupus, vasculitis, Sjögren’s syndrome), and crystal arthropathies (gout, pseudogout). Each presentation is approached with structured history, joint examination, autoimmune serology and inflammatory marker assessment before any imaging is considered.
- Joint pain and swelling — symmetric vs asymmetric, small vs large joints
- Morning stiffness lasting more than 30 minutes — inflammatory vs mechanical
- Multi-system symptoms — rash, oral ulcers, dry eyes/mouth, Raynaud’s
- Crystal arthritis — acute hot joint, podagra, tophaceous deposits
- Chronic inflammatory back pain — onset before age 40, improves with activity
Related: Rheumatology → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Evaluation approach
Rheumatological evaluation begins with a detailed history of joint symptom pattern (onset, distribution, morning stiffness duration, aggravating and relieving factors), family history of autoimmune disease, and systemic symptoms (fatigue, weight loss, skin changes, eye dryness). Joint examination assesses swelling, warmth, tenderness, range of motion and deformity patterns. Blood tests include inflammatory markers (ESR, CRP), autoimmune serology (rheumatoid factor, anti-CCP, ANA, anti-dsDNA, complement levels), and crystal analysis when gout or pseudogout is suspected.
Musculoskeletal ultrasound may be used point-of-care to assess synovitis, effusion and crystal deposition. Imaging (X-ray, MRI of sacroiliac joints when spondyloarthritis is suspected) is ordered when it would change management. The clinic follows treat-to-target principles for inflammatory arthritis, aiming for remission or low disease activity with regular monitoring.
- Inflammatory markers — ESR, CRP to quantify inflammation
- Autoimmune serology — RF, anti-CCP, ANA, anti-dsDNA, complement
- Musculoskeletal ultrasound — point-of-care synovitis and crystal assessment
- Targeted imaging — X-ray, MRI sacroiliac joints when indicated
- Treat-to-target — regular monitoring for remission or low disease activity