Dr. Abhijeet Bhosikar

Patient guide

Getting the most out of your rheumatology consultation

Rheumatology consultations depend heavily on history — often more than on tests. A well-prepared first visit routinely saves weeks of back-and-forth and a good deal of unnecessary repeat testing.

Before your visit

What to bring to your first appointment

Blood sample tubes in a laboratory rackIllustrative
Anti-CCP, RF, ESR and CRP are ordered to answer a specific question — not as a routine panel.
A blister pack of white tablets on a plain white surfaceIllustrative
Conventional DMARDs cost a fraction of biologics and control the majority of patients.

  • All previous reports, in order

    Every blood test, X-ray, MRI and ultrasound you have had, oldest first. Trends over time are often more informative than any single result. Digital copies on a phone are fine.

  • A written medication list

    Every prescription drug with its dose, plus painkillers, supplements, Ayurvedic and over-the-counter preparations. Photographs of the strips work well.

  • Your symptom timeline

    When it began, which joint was first, whether it moves around, how long morning stiffness lasts, and what makes it better or worse.

  • Family history

    Arthritis, psoriasis, thyroid disease, inflammatory bowel disease, lupus or recurrent eye inflammation in close relatives — all of these change diagnostic probabilities.

  • Practical clothing

    Loose clothes that let knees, elbows, hands and feet be examined without a struggle. Remove nail polish if hands are the main problem — nail changes are diagnostic clues.

  • Someone with you if useful

    A lot of information gets covered in a first consultation. A family member helps with recall, particularly for older patients.

Understanding your reports

What the common rheumatology blood tests really mean

A great deal of anxiety in this speciality comes from tests being ordered without a clinical question and then read in isolation. Here is what each one does and does not tell you.

Blood sample tubes in a laboratory rackIllustrative
Anti-CCP, RF, ESR and CRP are ordered to answer a specific question — not as a routine panel.

Look up a result from your report

Choose the test and what your report said. Most flagged results mean less than they look like they mean.

  • ESR / CRP

    What it measures
    General markers of inflammation.
    Important caveat
    Raised in infection and many other conditions too — never specific to arthritis on their own.

  • RA factor

    What it measures
    An antibody found in rheumatoid arthritis.
    Important caveat
    Also positive in healthy older adults, hepatitis C, TB and Sjögren's. A positive result alone is not a diagnosis.

  • Anti-CCP

    What it measures
    Highly specific antibody for rheumatoid arthritis.
    Important caveat
    Can turn positive years before symptoms and predicts more aggressive disease.

  • ANA

    What it measures
    Screening antibody for connective tissue disease.
    Important caveat
    Positive in 5–15% of healthy people at low titre. Pattern and titre matter; the specific antibodies matter more.

  • Anti-dsDNA

    What it measures
    Specific for lupus and tracks disease activity.
    Important caveat
    Rising levels with falling complement often precede a flare.

  • HLA-B27

    What it measures
    Genetic marker associated with spondyloarthritis.
    Important caveat
    Common in the general Indian population. Positive without inflammatory back pain means very little.

  • Serum uric acid

    What it measures
    Used in gout assessment.
    Important caveat
    Can be normal or low during an acute attack — must be rechecked at least two weeks afterwards.

  • Vitamin D

    What it measures
    Bone and muscle health.
    Important caveat
    Widely deficient in India despite sunlight. Corrected before starting osteoporosis drugs.
Seating in the waiting area outside the rheumatology consulting rooms in Ravet

On treatment

Immunosuppression is safe when it is monitored, and only then

The drugs that put rheumatic disease into remission also lower your defences. Everything below exists so that trade is a managed one — screened before you start, checked on a schedule, and adjusted before a problem becomes an emergency.

On treatment

Living safely with long-term immunosuppression

The general rules are below. For your specific drug — methotrexate, hydroxychloroquine, steroids, a biologic — the medicine guides go into detail.

Open the medicine guides

A gloved hand loading a blood sample tube into a laboratory analyserIllustrative
DMARD monitoring is a schedule, not a reaction: bloods every 2-4 weeks at first, then 8-12.
Shelves of medication bottles in a dispensaryIllustrative
Conventional DMARDs are inexpensive and widely stocked in India. Biologics are neither.

Monitoring schedule

  • Full blood count, liver and kidney function every 2–4 weeks initially
  • Every 8–12 weeks once the dose has been stable for three months
  • Annual lipids, blood pressure and HbA1c — inflammation raises cardiac risk
  • Eye screening after five years of hydroxychloroquine
  • DEXA scan for anyone on steroids beyond three months

Infection safety

  • Latent TB screening before any biologic — non-negotiable in India
  • Hepatitis B and C screening before immunosuppression
  • Vaccinations completed before starting where possible; no live vaccines after
  • Pause biologics during a significant infection, and tell any treating doctor you are immunosuppressed
  • Never stop steroids abruptly — they need tapering

Questions

Frequently asked questions

What does a positive RA factor actually mean?
Less than most people assume. Rheumatoid factor is positive in a meaningful proportion of healthy older adults, and in chronic infections such as hepatitis C and tuberculosis, in Sjögren's syndrome and in chronic liver disease. It is not a screening test for arthritis. Anti-CCP is far more specific for rheumatoid arthritis, and neither test replaces examining the joints.
My ANA came back 1:80 positive. Should I be worried?
Usually not. A low-titre ANA at 1:80 is found in a substantial minority of entirely healthy people, particularly women, and in relatives of patients with autoimmune disease. On its own, with no symptoms, it does not warrant treatment or repeat testing. What matters is the titre, the pattern, the specific antibodies, and above all whether there are clinical features.
Why do I need blood tests every few weeks on methotrexate?
DMARDs are monitored for liver enzyme rise, low blood counts and kidney function. The schedule is typically every two to four weeks for the first three months, then every eight to twelve weeks once the dose is stable. This monitoring is what makes long-term use safe — problems are picked up on a blood test long before they cause symptoms.
Which vaccines should I have before starting immunosuppression?
Ideally influenza (annual), pneumococcal, hepatitis B where indicated, and zoster vaccination in the relevant age group — given at least two to four weeks before starting, since live vaccines cannot be given once immunosuppressed. Latent tuberculosis screening is also mandatory before biologics in India. Your specific list is set at the consultation.
Can I take Ayurvedic or homeopathic medicines alongside my treatment?
Tell your doctor exactly what you are taking rather than concealing it — that is the important part. Some herbal preparations affect liver enzymes or interact with DMARDs, and some over-the-counter joint remedies in India have been found to contain undeclared steroids, which matters greatly for bone health and infection risk. Complementary therapies that relax and support you are not a problem; substituting them for disease-modifying treatment is.
What if I miss a dose?
For weekly methotrexate, take it as soon as you remember within two to three days, then return to your usual day — never double the dose. For daily medicines, skip the missed dose if it is nearly time for the next one. If you have missed several doses or stopped for a fortnight or more, contact the clinic before restarting rather than resuming on your own.
Should I stop my medication if I get a fever or infection?
For most biologics, JAK inhibitors and DMARDs, treatment is paused during a significant infection and restarted once it has fully resolved and any antibiotics are finished. Steroids are the exception and must never be stopped abruptly. Call the clinic rather than deciding alone — the answer differs by drug.
Can I drink alcohol on methotrexate?
It is best avoided. Both alcohol and methotrexate are processed by the liver, and combining them raises the risk of liver injury. If you drink occasionally, discuss it honestly at your consultation so that monitoring can be adjusted rather than assumed.

Ready to book, or still unsure whether you need a rheumatologist?

Call the clinic and describe your symptoms — reception can tell you whether a rheumatology consultation is the right next step, or whether another speciality fits better.

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