There is no question that the key player in your treatment team is you. Having arthritis isn’t easy, but learning as much as you can about your particular type of arthritis and actively working with your arthritis treatment team are two very effective ways of regaining control over your life. Remember that you’re not alone: take advantage of the help, advice, expertise and experience of your treatment team.
Here you will find a list of the various types of healthcare professionals and the services they provide. Please keep in mind that the services of a number of these professionals are provided to all Canadians as part of the Canada Health Act but some are only covered by certain provincial or territorial health plans or under employer or private insurance plans or out of pocket. A referral from your family doctor may be required to get payment for the service from your private insurance plan.
Where to get started with your treatment team?
Primary care is your gateway to the healthcare system. People with arthritis may have many different treatment needs, and may require the services of several different healthcare professionals. The place to start is with primary care services typically delivered by a family physician, general practitioner or nurse practitioner in private practice, including a team practice, a hospital clinic or a community health unit. This is the first level of care and usually the first point of contact that you have with the healthcare system.
Family physician or general practitioner
Your family physician or general practitioner is usually your first point of contact with the healthcare system and can provide the following services:
- examine you and take your history
- order lab work, X-rays and other tests
- consult other medical practitioners to evaluate your physical and mental health
- prescribe and administer medications and treatments
- perform and assist in routine/minor surgery
- provide emergency care
- provide acute care management
- inoculate and vaccinate
- deliver babies and provide pre-natal and post-natal care
- advise you and your family on health promotion and the prevention of disease, illness and accidents
- provide counseling and support to you and your family on a wide range of health and lifestyle issues
- advocate on your behalf – for example, in special cases when you require a treatment that is not publicly funded, your doctor may write a letter to the government requesting coverage of the treatment for you
- coordinate or manage your primary care – maintain a health record, with all tests and reports from other healthcare providers
- provide continuous care for ongoing health issues
- make referrals for home care services
- report births, deaths, and contagious and other diseases to governmental authorities.
Family physicians excel at getting you the right referral. They are often assigned the role of 'gatekeeper' for you to access other medical professionals, such as a rheumatologist, dermatologist, and orthopaedic surgeon. They can also refer you to the following services:
- exercise to maintain fitness and general health
- occupational therapy to help with daily living and functionality
- psychology to help optimise coping strategies and living well
- physiotherapy for specific musculoskeletal problems
- other doctors including requests for second opinions.
Nurses play key roles in a variety of settings to:
- conduct interviews to determine your medical history and assess the needs and problems you may have related to your arthritis
- coordinate your care with other members of the health care team
- administer medications
- perform minor medical procedures
Nurses can provide counselling and education on a wide range of issues, such as pain management and medications, and they can also refer you to community resources and other health care professionals.
Nurse practitioners provide direct care to people of all ages, families, groups and communities. You will find them in many healthcare settings:
- community care (community clinics, healthcare centres, doctors’ offices, and in patients’ homes providing a wide range of services)
- long-term care (nursing homes)
- hospitals (outpatient clinics, emergency rooms and other patient care areas)
- nurse practitioner-led clinics
In addition, they teach individuals and their families about healthy living, preventing diseases and managing illnesses.
Nurse practitioners can legally work in every province and territory, but the largest concentration is in Ontario.
Internist/ internal medicine specialist
An internist is a physician specialist trained in the diagnosis and treatment of a range of diseases in adults involving all organ systems, and is skilled in the medical management of patients who have multiple chronic diseases.
Internists practise in hospital or office settings and provide a link between family physicians and other specialists who provide care. In rural areas where access to a specialist may be limited, the internist would be able to advise other members of your treatment team whether a consultation with a specialist is needed. Internists that work in some remote or rural areas may have taken additional training in rheumatology and may be able to manage most forms of arthritis.
If you have inflammatory arthritis, such as rheumatoid arthritis or lupus, or a form of osteoarthritis (OA) that is difficult to manage, your doctor may refer you to a rheumatologist. A rheumatologist normally will diagnose inflammatory forms of arthritis.
A rheumatologist will assess, investigate, and manage:
- acute and chronic joint inflammation seen in most forms of arthritis
- soft tissue rheumatic disorders – problems that affect muscle tendons, fascia, bursae and joint ligaments
- collagen-vascular diseases – arthritic conditions that affect the tissue that holds bones, ligaments and muscles together
- vasculitis – inflammation of the blood vessels
- spinal and regional pain – arthritis conditions causing spinal joint problems and/or arm/leg pain involving inflammation of the nerves and other tissues
In Canada, rheumatologists are specialists who have trained at universities with arthritis centres. The purpose of an arthritis centre is to provide exemplary care and teaching while practitioners maintain an active role in research. The Arthritis Society helped establish the arthritis centres network in the 1950s to encourage a multidisciplinary approach that would not only facilitate solving the problems of arthritis, but ensure the highest-quality care for people with arthritis.
Many rheumatologists are based in hospital rheumatology clinics while others are based in the community and are affiliated with local hospitals.
An orthopaedic surgeon is trained in the surgical prevention and correction of disorders that involve the bones, joints and muscles, as well as other soft tissues like ligaments, tendons and cartilage. Most people with arthritis do not require surgery. However, in some rheumatic conditions, particularly OA, the damage to bone and cartilage requires surgical repair, which can include cleaning up bone and cartilage debris in a joint capsule or surgical replacement (total or partial joint replacement).
If you, your family physician and/or rheumatologist agree that your general health and particular joint problem might benefit from surgery, then you'll be referred to an orthopaedic surgeon. Seeing an orthopaedic surgeon doesn't necessarily mean you will need surgery. The surgeon may recommend that you continue with your current treatment strategy for the time being and be reassessed at a later date. And don't think of surgery as a last resort; surgery is just one part of your overall treatment plan. For some people — with severe osteoarthritis of the hip, for example — surgery may even be recommended at a relatively early age, as it may be the most effective way to reduce your pain and restore mobility.
Not all surgery is done by an orthopaedic surgeon; some specialized procedures are performed by doctors trained in other areas, including neurologists (who specialize in the nervous system), plastic surgeons (who treat skin and other soft tissue disorders), and ophthalmologists (who deal with problems concerning the eyes).
You may not expect a dermatologist to be part of your treatment team for your arthritis and related symptoms, but moderate to severe psoriasis is linked with psoriatic arthritis. For some people with psoriatic arthritis, they may first become aware of changes to their skin.
A dermatologist is a specialist in the prevention, recognition and treatment of diseases of the skin, hair and nails. Dermatologists treat disorders such as skin cancer, eczema and psoriasis.
An occupational therapist trained in arthritis management can analyze everything you do in a day and develop a program to help you protect your joints and minimize fatigue. If necessary, they can help you redesign your home or workplace to make it easier for you to work or simply get around. They can also make or recommend a number of different splints, braces, orthopaedic shoes and other aids that can help reduce your pain and increase your mobility and functionality. Their goal is to prepare you, using assistive tools, devices and adaptive strategies, to reclaim as much of your former life as possible.
Physiotherapists who specialize in arthritis are trained to do a full assessment of your physical abilities, based on the findings of a detailed examination. They note the degree of pain, swelling and discomfort you have in affected joints, as well as how much strength, flexibility and range-of-motion exists in both healthy and arthritic joints.
A physiotherapist can develop an individualized program that's designed to help you increase your strength, flexibility, range-of-motion, and general mobility and exercise tolerance through a wide variety of therapeutic treatments and interventions. These include exercise prescription, physical modalities and relaxation, in addition to advising you on other techniques for reducing pain and increasing your overall quality of life. Physiotherapists can also refer you to other health professionals and community services for further treatment options that will help you adapt to living with arthritis.
Most social workers play two roles in your health care. One involves helping you to get the service you require from government departments, outside agencies and organizations that provide benefits, such as health insurance, pension plans or home support. This could also include offering advice on job retraining and finding adequate housing, or suggest solutions to financial problems. Social workers are trained to provide clinical, face-to-face counselling to help with anxiety, depression and anger, supporting family members and assisting to find meaningful activities to replace those lost through arthritis.
Note: Anyone — whether they have formal training or not — can call him- or herself a counselor and provide counseling services, so be warned: Not all 'counselors' are equal.
Pharmacists are often overlooked, but potentially valuable members of your treatment team; choose one with the same care you'd select a doctor. If you find a pharmacist that you like and trust, and who has a sound knowledge of arthritis, become a faithful client. That way, he or she can keep a complete record of all the prescriptions you've filled and can tell right away if there are possible drug interactions and side effects.
If you're experiencing troubling side effects from your medication, and your doctor isn't available, check with your pharmacist. He or she should be able to tell you whether you require immediate medical attention or if it's safe and appropriate to simply reduce your dosage. (Either way, be sure to report the event the next time you talk to your doctor, who must keep an accurate picture of your treatment plan.)
As a person living with arthritis, you are likely have questions about diet and the impact it has on your condition. You might be concerned that some of the food you eat could interact with your medications, or you may have problems with your weight — keeping it down or keeping it up. You may simply have trouble preparing food and shopping for groceries. A dietitian can provide assistance in dealing with these problems. They're a reliable source of information on diet, vitamins, food and nutrition, and they can help you make healthy food choices to achieve your health goals.
Be careful where you get your advice: Anyone — whether they have special training or not — can call him or herself a nutritionist. A dietitian has a university degree in nutrition and dietetics, an internship or master's degree and registration with a provincial college of dietitians.
Chiropractors are trained in the prevention, assessment, diagnosis and management of musculoskeletal (MSK) conditions and associated neurological system. They will recommend a course of treatment to help relieve pain and improve function with the use of manipulation, mobilization, soft tissue therapy, exercise, education and modalities (i.e. ultrasound or laser). Chiropractors are also trained to provide injury prevention strategies.
A massage therapist can treat both acute and chronic conditions and work with a variety of patients of all ages, in the treatment of illness, injury rehabilitation and disability.
Massage therapists use their knowledge of physiology and anatomy to combine traditional and modern massage therapy techniques with other therapies to treat their clients. A registered massage therapist (RMT) has completed a 2-3 year program at a recognized massage therapy school.
Massage therapy is regulated in four provinces (British Columbia, Ontario, New Brunswick and Newfoundland) and all RMTs are registered with the College of Massage Therapists in one of those provinces. In the other provinces, RMTs are registered with an association and must follow its standards of practice.