Quick answer: At a first rheumatology appointment, a consultant, doctor in training or specialist nurse will ask about your symptoms, examine your joints and usually arrange blood tests and sometimes X-rays, ultrasound or MRI. You may leave with a diagnosis and treatment plan, a plan to wait for results, or discharge back to your GP. Bring a medicines list, symptom diary and your top questions.
Checked on 10 October 2026 against NHS: diagnosing rheumatoid arthritis, NICE NG100, NICE quality standard QS33 and NHS England guidance on patient initiated follow-up. Clinics vary, so your appointment may not follow every step below.
Going to a rheumatology clinic for the first time can feel daunting, especially after a long wait. Knowing what usually happens, and what you can do to prepare, helps you get the most out of a short appointment. This guide explains who you might see, what they will ask and examine, which tests are common, what the outcome might be, and what happens afterwards.
What a rheumatology team does
Rheumatology teams diagnose and treat conditions where the immune system or inflammation affects joints, muscles and other tissues. These include rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis (including ankylosing spondylitis), gout that is hard to control, lupus, polymyalgia rheumatica and other inflammatory or autoimmune conditions.
Most osteoarthritis is diagnosed and managed in primary care and community musculoskeletal (MSK) services rather than rheumatology. NICE says osteoarthritis can usually be diagnosed clinically without imaging. If you were referred with joint pain, the rheumatology team may confirm osteoarthritis and then send you back to your GP or community services for ongoing care.
Who you might see
- A consultant rheumatologist, the senior doctor who leads the team.
- A doctor in training, such as a registrar, working under the consultant's supervision.
- A clinical nurse specialist, who often runs follow-up, education and advice-line clinics and helps with starting medicines.
- Other team members, such as physiotherapists, occupational therapists, podiatrists and pharmacists, sometimes at the same visit and sometimes later.
NICE says adults with rheumatoid arthritis should have ongoing access to a multidisciplinary team and a named member of the team, for example the specialist nurse, who coordinates their care. If you are not told who that is, ask.
Before the appointment
Your appointment letter or text may ask you to:
- fill in a questionnaire about your symptoms and how they affect everyday tasks
- have blood tests or X-rays before you attend, so results are ready
- confirm or rebook the appointment, often online or by phone
- attend in person, by phone or by video. First appointments are usually face to face because the doctor needs to examine your joints
What to bring
- your appointment letter and any reference number
- a list of all your medicines, doses and supplements, including any you have stopped and why
- a short symptom diary: which joints, when it started, how long morning stiffness lasts, what makes it better or worse
- photographs of any swollen joints, rashes or nail changes taken on a bad day
- your family history, such as relatives with rheumatoid arthritis, psoriasis, inflammatory bowel disease, gout or lupus
- your top three questions, written down
- glasses, hearing aids and anything else you need to communicate easily
Wear loose clothing that lets the doctor see your hands, feet, knees, back or shoulders without a full change. If you need an interpreter, step-free access or a longer appointment, contact the clinic in advance.
Part 1: talking about your symptoms
Most of a first appointment is spent talking. The NHS says it is important to mention all your symptoms, not just the ones you think matter, because this helps the right diagnosis to be made. Expect questions such as:
- Which joints are affected, and is it the same on both sides?
- Do the joints swell, feel warm or look red?
- How long are you stiff in the morning? Inflammatory arthritis often causes stiffness lasting more than 30 minutes, while osteoarthritis stiffness is usually shorter.
- Is the pain worse after rest and better with movement, or worse with use?
- Have you had back pain that wakes you in the second half of the night or improves with exercise?
- Have you had rashes, psoriasis, mouth ulcers, dry eyes or mouth, red painful eyes, hair loss, bowel symptoms, fevers, weight loss or tiredness?
- What can you no longer do at home or at work?
- What medicines have you tried and did they help?
Be honest about how you are coping, including sleep, mood and work. These all affect treatment decisions.
Part 2: the examination
The doctor will look at and gently feel your joints, checking for swelling, tenderness, warmth and how well they move. They may also look at your skin, nails, eyes, spine and muscles, and check how you walk. The NHS says the specialist may assess how you manage everyday tasks, sometimes using a questionnaire about dressing, walking, eating and grip.
It is fine to say if something hurts or if you need to stop. You can also ask for a chaperone for any examination.
Part 3: tests you might have
There is no single test that proves or rules out most types of inflammatory arthritis. The team combines your story, the examination and tests.
- Blood tests such as ESR and CRP (markers of inflammation), a full blood count, and antibodies such as rheumatoid factor and anti-CCP. The NHS notes that about 1 in 20 people without rheumatoid arthritis test positive for rheumatoid factor, and not everyone with rheumatoid arthritis has these antibodies. See our guide to arthritis blood tests explained.
- X-rays. NICE recommends X-rays of the hands and feet for adults with suspected rheumatoid arthritis and persistent synovitis. See X-rays explained.
- Ultrasound, sometimes done in the clinic, to look for inflammation in joints and tendons.
- MRI, for example of the spine and pelvis when axial spondyloarthritis is suspected. See MRI scans explained.
- Joint fluid tests, where a small sample is drawn from a swollen joint with a needle to look for crystals (as in gout) or infection.
Some tests are done on the day; others are booked for later. Ask how and when you will get the results.
Possible outcomes of a first appointment
You might leave with any of these:
- A diagnosis and treatment plan. For rheumatoid arthritis, NICE's quality standard says adults with active disease should start a disease-modifying medicine (cDMARD) within 6 weeks of referral, with monthly monitoring until their treatment target is met. Treatment may also include a short course of steroids or a steroid injection to settle inflammation quickly.
- A probable diagnosis, pending results. The team may want test results before deciding.
- Referral to other members of the team, such as physiotherapy, occupational therapy or podiatry.
- Reassurance and discharge. If you do not have an inflammatory condition, you may be discharged with advice and a letter to your GP. This is a good outcome, even if it feels disappointing. Ask what the likely cause is and who will manage it.
If you start a new medicine
Disease-modifying medicines such as methotrexate, sulfasalazine, hydroxychloroquine and leflunomide work slowly, often over weeks to months. Many need regular blood tests to check for side effects, and your GP may share this monitoring with the hospital. Before you leave, make sure you know:
- the name of the medicine, the dose and how often to take it (methotrexate is taken once a week, not daily)
- which blood tests you need, how often and where
- what side effects to report, and who to call
- whether you need any vaccinations or checks before starting
- what to do if you get an infection
Our guide to starting a new arthritis medicine has a fuller checklist.
After the appointment
- Clinic letter. The team writes to your GP. Many clinics also send a copy to you. If you do not get one, ask.
- Follow-up. You may get a set follow-up appointment or be placed on patient initiated follow-up (PIFU). NHS England describes PIFU as a way for you to arrange a follow-up when you need one, based on your symptoms. Make sure you know how to book it and what symptoms should prompt you to call.
- Advice line. Many rheumatology departments have a nurse advice line. NICE's quality standard says adults with rheumatoid arthritis who have a flare or possible side effects should get advice within 1 working day of contacting rheumatology services.
- Annual review. NICE says all adults with rheumatoid arthritis, including those whose disease is well controlled, should be offered an annual review.
Telephone and video follow-ups
Many follow-up appointments are now by phone or video, especially when your condition is stable or the purpose is to review results. To make these work well:
- find a quiet place with good signal, and have your medicines list and diary to hand
- check the time and whether the clinic will call you or you need to join a link
- be ready for calls from a withheld number
- say clearly if you think you need to be seen in person, for example because joints are newly swollen
If you feel anxious about the appointment
It is common to worry about what you might be told, or that you will not be taken seriously. Writing things down beforehand helps, as does bringing someone with you. If you have been waiting a long time, it is understandable to feel frustrated; staying focused on your symptoms and what you need from the visit usually leads to the most useful conversation. If you have a hidden disability, a learning disability, autism, or difficulty with hearing or speech, tell the clinic in advance so reasonable adjustments can be made.
Afterwards, it is normal to need time to take in a new diagnosis. Ask for written information, and use reliable sources such as the NHS, NICE patient information, Arthritis UK or the National Rheumatoid Arthritis Society rather than forums alone.
Differences across the UK
Rheumatology clinics work in a similar way across England, Scotland, Wales and Northern Ireland, and NICE guidance is widely used. The main differences are in waiting times, how referrals are booked and how you raise concerns. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) also publishes guidance, and Healthcare Improvement Scotland advises on medicines. In Wales and Northern Ireland, NICE guidance generally applies. Our waiting list guide explains the rules for each nation.
Tips for a productive appointment
- Put your most important question first, in case time runs out.
- Bring someone with you to take notes, or ask if you can record the conversation for your own use.
- Ask the clinician to repeat or write down anything you do not understand.
- Before you leave, summarise the plan in your own words: "So the next step is…"
- Ask what the plan is if things get worse before your next appointment.
Our list of questions to ask your consultant can help you prepare.
When to get medical help
Do not wait for your next rheumatology appointment if:
- a joint suddenly becomes hot, very swollen and painful, or you feel feverish or unwell. Ask for an urgent GP appointment or contact NHS 111
- you take a disease-modifying or biologic medicine and develop a fever, sore throat, unexplained bruising or bleeding, mouth ulcers, breathlessness or yellowing of the skin or eyes. Contact your rheumatology advice line, GP or NHS 111 the same day
- you develop a painful red eye or sudden change in vision. Get help the same day
- you have chest pain or severe breathlessness. Call 999
Frequently asked questions
How long is a first rheumatology appointment?
It varies by clinic. First appointments are usually longer than follow-ups because they include a full history and examination. Your letter may give an estimated time; allow extra time for tests.
Will I get a diagnosis at my first appointment?
Sometimes. Often the team needs blood test or scan results first. Ask when you will hear and who will contact you.
Can I bring someone with me?
Yes. A relative or friend can help you remember what was said and ask questions you might forget.
What if I am discharged?
Discharge usually means the team does not think you have a condition that needs ongoing specialist care. Ask what the likely diagnosis is, what will help, and when to go back to your GP.
Do I need to stop my painkillers before the appointment?
Not usually. Keep taking your medicines unless the clinic tells you otherwise, and tell the doctor what you have taken.
What is patient initiated follow-up?
It means you contact the clinic for a follow-up when you need one, instead of having routine appointments booked. Make sure you know how to get in touch and which symptoms should prompt you to call.
Can I ask for a second opinion?
You can ask. There is no automatic legal right to a second opinion, but your GP or consultant can arrange one if it is appropriate. Explain what you are unsure about, as a conversation with the same team sometimes resolves it.
Sources and further reading
- NHS: Rheumatoid arthritis – diagnosis
- NICE NG100: Rheumatoid arthritis in adults
- NICE QS33: Rheumatoid arthritis in over 16s – quality statements
- NICE NG226: Osteoarthritis in over 16s
- NICE NG65: Spondyloarthritis in over 16s
- NHS England: Patient initiated follow-up
- NHS: Septic arthritis
- Healthwatch: Getting a second opinion about your care
Educational information for people in the United Kingdom, not personal medical, legal or financial advice. NHS processes, rules and prices change, so check the linked official sources and speak to your GP, specialist team or pharmacist about your own situation. Charity no. 1218461. Pending clinical review. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Surviving NHS waiting lists — your rights and what to do while you wait
- Questions to ask your consultant — a printable list
- Arthritis blood tests explained — what the results mean
- How NHS referrals work — from GP to specialist
- Starting a new arthritis medicine — what to check before you begin