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 can affect the joints (arthritis is the most common), muscles, and bones causing pain, swelling, stiffness, and deformity.

While many of these disorders affect multiple organ systems, and people with rheumatic conditions can become acutely unwell with life-threatening complications, the past few decades have seen remarkable advancements in the treatment of rheumatological conditions and improved patient outcomes as a consequence, state the authors of a 2016 article in the BMJ. As a result, most people with rheumatic conditions should expect to have a good (including functional) outcome from treatment.

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 alone. These are among the most common:

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 like Lupus, Scleroderma, and Vasculitis

Other diseases that result when your immune system goes haywire and attacks its own cells and tissue include systemic lupus erythematosus (commonly known as lupus, an inflammatory disease that affects joints and organs), scleroderma (a group of diseases that cause abnormal growth of connective tissue), and vasculitis (an inflammation of the blood vessels of the body).

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.

Gout

A type of arthritis that most often affects the big toe, gout can trigger severe pain, redness, and tenderness.

Chronic Back Pain

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

Myositis

Myositis is a disease category that includes conditions, such as inclusion body myositis, where there is inflammation of muscle. 

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 their covering (fascia), and not the joints.

Tendonitis

Tendonitis is inflammation of a tendon, the tough, flexible bands of fibrous tissue that attach muscle to bone.

Raynaud's Phenomenon

Raynaud’s Phenomenon results when there is a decrease in blood flow to the fingers and toes when someone is exposed to cold weather or stress. Primary Raynaud’s occurs in people who don't have another rheumatic disease. Secondary Raynaud’s is “secondary” to another condition, including common rheumatic diseases like scleroderma and lupus.

Procedural Expertise

Diagnosis

To help confirm or exclude a diagnosis, rheumatologists take a complete medical history, do a physical exam, and order blood tests and imaging tests like X-rays, MRIs, ultrasounds, CT scans, and bone density scans (DXA) to look for markers of disease, such as specific antibodies, inflammation, joint damage, and bone loss. Diagnostic procedures are usually limited to taking a sample of fluid, the lining of the joint (synovium), or other tissues for microscopic examination:

Joint aspiration: This test may be performed when there's unexplained pain, inflammation of a joint, or suspected infection in a joint. A sample of synovial (joint) fluid is removed from the joint with a needle and examined in the laboratory.

Synovial biopsy: A sample of the tissue lining a joint (synovial membrane) is examined to diagnose arthritis and rule out 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 where joints are injected with synthetic joint fluid. This treatment may postpone the need for surgery at least temporarily and improve the quality of life for arthritis patients.

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

Training and Certification

After four years of medical school and three years of training (residency) in either internal medicine or pediatrics, rheumatologists devote an additional two to three years to 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 thinking.

Appointment Tips

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

If your primary care doctor refers you to a rheumatologist, you'll probably see one your doctor is familiar with. Otherwise, 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 medications you take, both pharmaceutical and over-the-counter (include dosage and how often you take it), and to include any information that can aid in the diagnosis (including past hospitalizations or a family history of rheumatoid disease). In this way, you can get the facts straight and avoid forgetting things.

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

Know the dates of pertinent visits to other doctors related to your current situation, including orthopedic surgeons and your primary doctor. Be able to describe your current symptoms and when they started. If you have prior X-rays that are related to your current symptoms, acquire the X-rays and reports so the information can be included. Bring information about past surgeries, including procedures, dates, and the name of surgeons.

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