What Is a Rheumatologist?

These specialists treat arthritis and other related diseases

A rheumatologist is an internist or pediatrician who's a specialist in the non-surgical treatment of autoimmune, inflammatory, or other musculoskeletal conditions commonly referred to as rheumatic diseases. These diseases typically affect the joints (arthritis is the most common), muscles, and/or bones, causing pain, swelling, stiffness, and deformity. They can also affect the skin and any connective tissue or organ in the body, sometimes leading to symptoms that can include fatigue, fevers, or organ failure.

Woman at rheumatologist
BSIP/Getty Images

Many of these disorders affect multiple organ systems and can cause acute symptoms, sometimes with life-threatening complications. The treatment of rheumatological conditions can improve symptoms and prevent serious complications.

Rheumatic diseases are common; according to the Centers for Disease Control and Prevention (CDC), they affect an estimated 54.4 million people—including almost 300,000 children—in the United States.

Concentrations

There are more than 200 types of rheumatologic diseases, including more than 100 types of arthritis. There are several categories of rheumatic diseases, and there is some overlap—many conditions fit into more than one category.

Osteoarthritis

The most common form of arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

Rheumatoid arthritis

The most common type of inflammatory arthritis, rheumatoid arthritis is an autoimmune disease in which the body's immune system mistakenly attacks the joints.

Autoimmune Diseases

Other diseases that result when your immune system attacks its own cells and tissue include:

  • Systemic lupus erythematosus, commonly known as lupus, is an inflammatory disease that affects joints and organs.
  • Scleroderma is a group of diseases that cause abnormal growth of connective tissue.
  • Vasculitis is an inflammation of the blood vessels of the body.

Rheumatoid arthritis, lupus, inflammatory myopathy, scleroderma, and Sjogren are among the many autoimmune disorders that involve connective tissue.

Osteoporosis

Also known as "brittle bone disease," osteoporosis is a condition that results from a loss of bone density and a change in bone structure.

Auto Inflammatory Disorders

A type of arthritis that most often affects the big toe, gout can trigger severe pain, redness, and tenderness. Other autoinflammatory disorders include Behcet's and familial Mediterranean fever (FMF).

Chronic Back Pain

Many types of rheumatic disease affect the spine, causing chronic back pain. The most common is osteoarthritis, which can cause both cartilage and bone to deteriorate. Spondyloarthritis is a type of arthritis that attacks the spine and causes low back pain.

Psoriasis, psoriatic arthritis, and ankylosing spondylosis can also cause inflammation and pain in the back.

Myositis

Myositis is a disease category that includes conditions that involve inflammation of the muscle, such as inclusion body myositis

Fibromyalgia

Fibromyalgia is a chronic disorder that causes widespread pain, fatigue, and other types of discomfort. Symptoms resemble those of arthritis, but fibromyalgia affects soft tissues, such as muscles and fascia (the muscle covering), and not the joints.

Overuse Injuries

Tendonitis is inflammation of a tendon, which is a tough, flexible band of fibrous tissue that attaches muscle to bone.

Raynaud's Phenomenon

Raynaud’s Phenomenon causes a decrease in blood flow to the fingers with exposure to cold weather or stress.

  • Primary Raynaud’s is diagnosed when it occurs in the absence of another rheumatic disease.
  • Secondary Raynaud’s occurs secondary to another condition, including common rheumatic diseases like scleroderma and lupus.

Interstitial Lung Disease

Interstitial lung disease includes diseases characterized by scarring or inflammation of the lungs. Sarcoidosis is a rare form of interstitial lung disease.

Procedural Expertise

Rheumatologists diagnose and treat these types of diseases. If you have symptoms of rheumatic disease, you may be referred to a rheumatologist. And if you are diagnosed with one of these conditions, you may need to regularly see a rheumatologist for management of your illness.

Diagnosis

During the diagnostic process, rheumatologists take a complete medical history and do a physical examination. They often order blood tests, which can detect markers of inflammation, such as elevated white blood cells or specific antibodies.

Imaging tests like X-rays, MRIs, ultrasounds, CT scans, or bone density scans (DXA) can identify problems such as joint damage and bone loss. Diagnostic procedures may involve procedures for sampling fluid or other tissues for microscopic examination.

Procedures can include:

Joint aspiration: During this procedure, a sample of synovial fluid (from the joint lining) is removed from the joint with a needle and examined in the laboratory. You may need this test if you have unexplained pain, joint inflammation, or a possible joint infection.

Synovial biopsy: During this procedure, a sample of the synovial membrane (tissue lining the joint) is examined. The test may help in the diagnosis of arthritis or joint infections.

Treatment

Many rheumatoid conditions can be treated or managed with medications. These include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and acetaminophen, corticosteroids like prednisone, disease-modifying antirheumatic drugs (DMARDS) like methotrexate, and biologic agents like Enbrel (etanercept) and Humira (adalimumab). Medications may be taken orally or administered through self-injection. They may also be given as an intravenous infusion (IV or “drip”) into a vein (infusion therapy).

Rheumatologists may also perform hyaluronic acid injections, an arthritis treatment in which joints are injected with synthetic joint fluid. This treatment may postpone the need for surgery and improve the quality of life for people who have arthritis.

Rheumatologists do not perform surgery. People who require surgery—to replace a joint damaged by arthritis, for example—would be referred to an orthopedic surgeon.

Training and Certification

After four years of medical school and three years of residency training residency in either internal medicine or pediatrics, rheumatologists devote an additional two to three years to a specialized rheumatology training fellowship to learn about chronic musculoskeletal and autoimmune conditions and their treatment.

Most rheumatologists who plan to treat patients choose to become board certified. Upon completion of their training, they must pass a rigorous exam conducted by the American Board of Internal Medicine to become certified. This certification/exam has to be retaken every 10 years. Physicians are also required to participate in a certain amount of continuing medical education on a yearly basis to ensure they stay abreast of current medical developments.

Appointment Tips

If you’re dealing with osteoarthritis, your primary care physician can likely help you manage the disease. But if you develop complications, have an especially severe case, or develop another rheumatic disease, you may be referred to a rheumatologist.

Your primary care doctor may refer you to a rheumatologist or you can find a rheumatologist through the American College of Rheumatology, the national professional organization for rheumatologists in the United States. 

To get the most out of a rheumatology appointment, arrive early and bring any tests, reports, or imaging studies relevant to your condition. You can ask your primary care physician to forward these electronically in advance of your appointment.

It helps to write down all of the over-the-counter and prescription medications you take, including dosage and how often you take it. Be prepared with information about your past hospitalizations and find out whether you have a family history of rheumatoid disease.

Before your appointment, check that the office accepts your health insurance. You should also find out what labs are in-network providers. If not, you may be faced with higher out-of-pocket expenses.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.