“Having rheumatologists and orthopedists in the same practice has been a really successful model,” Dr. Levine says. Still, even if you can’t partner directly with an orthopedic peer, you can identify someone for a good flow of communication, he says.
Explore this issueAugust 2018
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2. Know when to refer. As you might expect, orthopedic surgeons want to see rheumatological patients when medications and interventions are no longer effective and a patient’s pain and functional status continue to get worse, Dr. Parks says. “This is often the best time to refer a patient to the orthopedic surgeon to discuss surgical options, specifically, hip or knee replacement,” he says.
If a total replacement isn’t necessary yet, the orthopedic surgeon can discuss other options such as arthroscopic synovectomy, Dr. Reznik says. This option is often underused but can provide up to three years of relief and may be a good way to get a patient off higher dose medications in the short term, he explains.
Other treatments provided by the orthopedic surgeon include brace prescriptions and fusions, says Dr. Smith.
3. Refer early. “For many conditions, earlier intervention, before significant deformity occurs, is less complex and has better outcomes,” Dr. Reznik says. “If we wait too long, sometimes the damage is irreversible, or the bone stock is destroyed—and replacement of the joints is less likely to be possible or work well.”
4. Think beyond just rheumatological disease. “Just because the patient has an inflammatory disease does not mean they don’t have a meniscus tear, loose body, malalignment or a ligament tear,” Dr. Reznik says. On a similar note, Dr. Reznik has observed that many patients want magnetic resonance imaging (MRI) for their problem, and they often ask their rheumatologist to order one. Because an MRI is not always necessary, he advises referring the patient to an orthopedic surgeon and letting them decide if one is actually needed.
5. Pick up the phone. “If you’re worried about something specific, send me a consult note. However, it’s easy in a big consult note to miss a little point. If there’s a specific issue, a phone call is best,” Dr. Gibson advises.
Dr. Levine agrees. “The main thing [the rheumatologist] needs to do is identify what they need us to do,” he says. “Make it clear in the notes and any conversation. Then we can have a productive time with the patient.”
Vanessa Caceres is a medical writer in Bradenton, Fla.