Q: How do most patients get referred to a rheumatologist in the first place? Kremer: Usually, it’s the pain that’s perceived to be arthritis pain. Sometimes it’s muscle pain. Other times it can just be a nagging pain from anywhere that the primary care provider cannot diagnose. It’s more helpful to be referred to a rheumatologist when there are other symptoms along with the pain, such as early joint swelling. Q: What does the rheumatologist do when they see a referred patient? Kremer: We’ll take a history. Do you have morning stiffness? Fatigue? How long has this been going on? Do you have any family history of these same symptoms? After history, you do a physical exam looking for impaired joint movement, which joints are swollen, warm to the touch, difficult to move. Q: When do you take lab tests? And which tests do you start with first? Kremer: It depends on where the initial history and exams lead you. You many test for Rheumatoid factor (...
I recently saw the following question:
My feet feel like something is stuck to the bottom of them all the time. They burn sometimes and sometimes they feel like pins are sticking in them. What can I take to make them feel better? I have type 2 diabetes, and am taking Glucophage.
Sounds like you probably have diabetic nerve damage. This presents with numbness, dysesthesias (odd and somewhat painful sensations), and/or pain in the feet. This form of neuropathy is frequently called peripheral neuropathy (or more precisely, distal symmetric sensory polyneuropathy). It is common in people with diabetes, and is usually attributed to long-term lack of control of diabetes – but it may also have additional causative factors including (among others) alcohol abuse, neurotoxic medications, and vitamin B12 deficiency. These should be investigated, and if present, treated. If no other factors are found, then the standard treatments for peripheral neuropathy s...
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