Frequently Asked Questions

Are you accepting new patients?

Yes, please contact our office at (503) 297-3384 option 2, to schedule your first appointment.

What to expect at my first appointment?

You can expect to have a comprehensive evaluation of your symptoms and a detailed discussion regarding the next steps, whether it is continued treatments with rheumatology clinic, or a recommendation to follow back with your referring / primary care provider.

It is very helpful to bring any relevant lab or other tests, prior provider notes to your appointment. Please make a list of your symptoms and course through time. Please also make a list of your questions so you don't forget to ask anything important.

New patient appointment are for 40 minutes, but may take less or more time depending on various factors. Your arrival at check in time will allow us time to process your paperwork and ensure you are ready on time for your appointment. Checking in late, at best, takes precious time away from your allotted time; and at worst, might result in you being rescheduled.

What do I need to bring to my appointment?

Please bring the following to your appointment:

1. Photo ID
2. Current insurance card(s) including prescription cards.
3. Co-payment(s) if required.
4. If you have Medicare, please bring your pharmacy insurance drug card.

What are the office hours of NWRA?

Our office is open Monday through Friday from 8:00 a.m. – 5:00 p.m.

Is the office closed for lunch?

The office is not closed for lunch.

What should I do if your office is closed and I need medical care?

If you are experiencing a medical emergency, please call 9-1-1 or go to the closest Hospital Emergency Department. To page the on-call physician after hours for urgent matters, please call the main number at (503) 297-3384 and follow the prompts. After you leave your message, the physician will be paged.

May I have a relative or friend accompany me into the appointment?

Absolutely, however if your guest is late they will be asked not to interrupt your appointment with the physician and will be asked to wait until your appointment has been completed.

May I bring my children?

Yes. However we find that the appointment process generally goes more smoothly without the distraction of children present.

How do I request my medical records?

Please complete the attached request form to release your medical information and either -

  • fax it to 503-297-0863, or
  • mail it to 9555 SW Barnes rd suite 150 Portland OR 97225, or
  • send it via patient portal.

Please be sure to include medical records recipient’s contact information and feel free to contact our medical records team for any concerns or questions at 503-206-3053.

How do I log onto the portal?

If you are an established patient, please reach out to our office so that we can confirm your e-mail and send you an invitation to sign up for your patient portal.

If you are a new patient, you will receive an email invitation at your first appointment.

Should I get the new COVID Booster?

Yes. You should get the new covid booster when available.

What are your billing requirements?

Patients must pay their co-payments at the time of their visit. It is the patient’s responsibility to pay any amounts, such as deductibles, co-payments and co-insurance that their insurance company has designated as their responsibility.

What insurance carriers does Northwest Rheumatology Associates accept?

Please see our insurance list.  If you don’t see your insurance carrier on the list, call for more information.

When do you collect copay?

Copay is collected at the time of the visit. 

What health plans do you accept?

We currently accept these health plans.

Why was my prescription refill denied? Why do I have to do labs so often?

Most likely the medication refill was denied due to NWRA not receiving your lab results in time. Either you have not had your labs or the lab has not sent the results to NWRA. If your labs are due and you have not had your labs, it would be faster to get the labs done and then notify the clinic for requesting a refill.

Most immunosuppressive medications can have harmful effects on the body. To monitor for these, it is vital to check blood tests at regular intervals, usually every 3 months. Without checking these blood tests, you or your rheumatologist cannot be sure that it is safe to continue the medication at the dose you are currently taking. Based on the blood tests, your medication may need to be discontinued or the dose may need to be adjusted.

What should I do if my prescription runs out over the weekend?

No routine prescriptions will be available for refill until Monday morning.  Please check your supply before the weekend.

When are labs due?
Labs are checked routinely to make sure your body can tolerate the medication being prescribed to you. Labs are due at set intervals for different medications, usually every 3 months.
 
Please set a reminder on your calendar. Lab or your provider will not call you to remind you.
 
It is helpful to carry a printed copy of your lab order to the lab as sometimes the lab does not keep it for you even if your provider has faxed it over. Please ask for it from your provider at your visit. 
If I am sick, do I hold my meds/ reschedule my infusion?

Yes. For most infections, especially if you have a fever, you may need to hold your immunosuppressive medications, except Hydroxychloroquine. In general you would need to hold Methotrexate, Sulfasalazine, Leflunomide, Azathioprine, Mycophenolate, Xeljanz, Rinvoq, Olumiant, and any biologics/ infusion medications.

Please check and confirm with the office by calling or emailing your provider on your patient portal.

I am having surgery, should I hold my meds?

Yes. You will need to hold medications for most major surgeries to allow for proper wound healing. Similarly, schedule surgery at an appropriate interval from the infusion of an immunosuppressive medication, and allow a few weeks of healing before scheduling your next infusion.

Please check with clinic regarding your specific medication.

How do I request a refill?
Please contact your pharmacy to request a refill.
How long does infusion take?

Infusion times vary depending on the medication. It can take anywhere from 30 mins to 4 hours, plus time taken to check in, place an intravenous line. Please allow sufficient time to allow our team to treat you with kindness and care, without rushing through the process.

What is a rheumatologist?

A rheumatologist is an internist or pediatrician who has received training in the diagnosis and treatment of autoimmune diseases including certain kinds of arthritis and other musculoskeletal diseases. Also called “rheumatic” diseases, these diseases can affect the skin, joints, muscles and other body organs (eyes, lungs, kidneys, nervous system).

Who do rheumatologists treat?

Rheumatologists treat patients with autoimmune diseases affecting skin, joints, and other body organs, and osteoporosis. Some examples of diseases treated by rheumatologists include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, lupus, sarcoidosis etc. A list of such diseases treated by rheumatologists at NWRA is also here.

To learn more about various diseases treated by rheumatologists, please check out our resources section. American College of Rheumatology has excellent information all the diseases treated by rheumatologists and updated information a variety of different medications currently being used to treat these conditions.

What kind of training do rheumatologists have?

Rheumatologists must first complete medical school and three years of residency training in primary care (either internal medicine or pediatrics). After taking a national exam to become board certified, rheumatologists devote two to three years to specialized training in an accredited rheumatology fellowship program.

Most rheumatologists then become board certified in rheumatology after their fellowship training, by the American Board of Internal Medicine.

Rheumatologists must continue to complete the maintenance of certification (MOC) requirements set by the board at regular intervals throughout their practicing career. This process ensures that they have kept their medical skills and knowledge up to date.  All of our physicians are board certified.

When should I see a rheumatologist?

There can be many symptoms of autoimmune diseases. If you have a persistent or unexplained symptom such as rash, joint pain or swelling, joint deformity, muscle weakness, a lung problem etc., which has not been explained by your or other physicians you may need to consult with a rheumatologist. In general, for arthritis, if your joint pain or swelling persists for more than a few days you should see your physician. Your physician will then determine if your symptoms are concerning for an autoimmune / rheumatic disease and will refer you to a rheumatologist.

What will happen when I see the rheumatologist?

Rheumatologists are specially trained to discover the cause of symptoms related to autoimmune diseases. They will usually ask a detailed history of the problem and will undertake a physical examination. Additional investigations such as blood tests, x-rays and scans may also be needed.

Once a diagnosis is made, your rheumatologist will explain the nature of your illness and what you might expect in the future. With an accurate diagnosis and a shared understanding of your illness, you and your rheumatologist can work together to design a treatment program aimed at managing pain, reducing inflammation and ensuring your quality of life.

Depending on the nature of your illness, you may need to see your rheumatologist regularly for ongoing management. Alternatively, your primary physician may treat you, with the rheumatologist on hand for specialist advice.

How will my condition be treated?

As your rheumatologist will explain, there are a number of treatment options available including:

  • Physical Therapy
  • Medications
  • General Supportive Care
  • Surgery

They will help you select the best treatment combination for you, depending on your illness and other individual needs. In treating and managing your illness, your rheumatologist will work closely with your primary physician as well as other skilled professionals to ensure you get the best possible care.

Is specialty care more expensive?

You may be surprised to learn that specialized care may save time and money and reduce the severity of the disease. A rheumatologist has special training to spot clues in the history and physical exam. The proper tests done early may save money in the long run. Prompt diagnosis and specially tailored treatment often save money and minimize the long-term effects of rheumatic diseases.

What medications are used to treat rheumatic diseases? Why should I lower my immunity?

Great question!

Autoimmune diseases can not only affect skin and joints, but also other body organs such as lungs, kidneys, muscles, eyes etc. To treat autoimmune conditions caused by an overactive immune system, rheumatologists often recommend immunosuppressive medications. Immunosuppressive medications are designed to target cells, chemicals and proteins of the immune system. By targeting/ blocking these chemicals, these medications are able to suppress the inflammatory attack of the immune system on the body.

A vast amount of quality research in the form of randomized controlled trials (RCTs) support the use of immunosuppressive medications in the treatment of autoimmune diseases.

In many instances, suppressing the immune attack on the body organs is absolutely necessary, or even life saving, to control the adverse impact of an overactive/ abnormal immune system on our bodies. As such, immunosuppressive medications have provided tremendous benefit by improving symptoms, function and quality of life of patients suffering from these conditions worldwide.

Our immune system is very important for a healthy life. Hence, immunosuppression can cause serious adverse effects including infections, cancers, and should only be handled by experts.

A great resource to learn about various medications used in rheumatology practice can be found here at the American College of Rheumatology.

 

What are DMARDs?

To treat autoimmune conditions caused by an overactive immune system, rheumatologists recommend immunosuppressive medications. Some of these medications, especially in the context of Rheumatoid arthritis, are called DMARDs (Disease Modifying Antirheumatic Drugs), as these are designed to 'modify' the disease course from a diseased state to a healthy state.

As such, they are fundamentally different from analgesics (pain killers) such as Acetaminophen, or NSAIDs (Non-steroidal anti-inflammatory drugs) such as Ibuprofen, Naproxen etc., or steroids (e.g prednisone), which only provide symptom relief and do not 'modify' the disease course.

DMARDs and other immunosuppressive medications target inflammatory cells, proteins and chemicals in the body. By inhibiting these chemicals, these medications are able to suppress the inflammatory attack of the immune system on the body.

What are traditional vs. biologic vs. targeted synthetic DMARDs?

Traditional DMARDs, aka conventional synthetic DMARDs (csDMARDs) are synthesized in a laboratory ('synthetic'). They have been on the market the longest ('traditional' / 'conventional') and have the most evidence of benefit for autoimmune diseases. Examples of traditional DMARDs include Methotrexate, Leflunomide, Sulfasalazine, Azathioprine (Imuran) and Hydroxychloroquine. These have a broad immune suppressing effect and are usually not designed to block a specific protein, chemical or cell of the immune pathway. These are usually taken orally or by injection (Methotrexate).

Biologic DMARDs are derived from cell lines (hence the term 'biologic'). These are complex large molecules designed to target specific proteins, chemicals or cells of the immune system. Examples of biologics include Infliximab (remicade), Golimumab (Simponi), Adalimumab (humira), Etanercept (Enbrel), Abatacept (Orencia), Tocilizumab (Actemra), Rituximab (Rituxan), Belimumab (Benlysta), Anifrolumab (Saphnelo), Ustekinumab (Stelara), Secukinumab (Cosentyx), Risankizumab (Skyrizi), Ixekizumab (Taltz),

Targeted synthetic (tsDMARDs) are synthesized in a laboratory ('synthetic') but these are small molecules synthesized to also target specific proteins, chemicals or cells of the immune system. Examples of tsDMARDs include Tofacitinib (Xeljanz), Upadacitinib (Rinvoq), Baricitinib (Olumiant).

By targeting/ inhibiting these chemicals, biologic and tsDMARDs are able to suppress that pathway of the immune system very well, and hence are usually more effective than the traditional DMARDs, at the cost of being more strongly immunosuppressive.

All varieties of DMARDs have pros and cons, and are recommended for treating various autoimmune diseases. You should discuss the pros and cons of all medications with your rheumatologist to decide on the best choice for you.

What are biosimilars?

The FDA defines a biosimilar as “a type of biological product that is licensed by the FDA because it is highly similar to an already FDA-approved biological product (the reference product) and has been shown to have no clinical differences from the reference product. The key consideration is that biosimilars are similar, but not identical, to their reference product. This article table summarizes this topic in great detail; you can also find more information here.

What vaccinations I should get?

We recommend you get all vaccinations appropriate for your age and demographics. Please consult with your primary care physician for routine adult vaccinations recommended in the United States. 

In particular, for our immunocompromised patients, we strongly recommend the latest versions available of annual flu vaccine, pneumonia vaccine (Prevnar 20), shingles vaccine  (Shingrix) and COVID vaccine. 

How do I give a subcutaneous injection?

Some medications such as Kineret and Enbrel must be injected. These medications come with a kit and a device to inject the medication. Some patients however prefer not to use the kit but to do the injection themselves; much like an insulin injection would be done.  Instructions for performing a subcutaneous injection can be found here.