When to See a Rheumatologist for Your Back Pain

Back pain is one of the most common reasons for seeking health care. Depending on what's causing your back pain, you may need to see a rheumatologist.

Rheumatologists are doctors who specialize in diagnosing and treating certain inflammatory disorders. This includes inflammatory joints diseases, such as arthritis, and autoimmune conditions like lupus and Sjögren's syndrome.

This article helps you understand when you should see a rheumatologist for your back pain, and the differences between rheumatologists and other specialists who often treat back pain.

What Is a Rheumatologist?

A rheumatologist is an internist or pediatrician who has completed special training in treating conditions that are:

• Inflammatory
• Autoimmune (when the immune system attacks healthy cells as if they are invaders)
• Related to painful joint disease (rheumatism)

They're typically the doctors who diagnose, treat, and manage these conditions long term. They may also lead or be part of a team including other healthcare providers, depending on your diagnosis and care needs.

For example, if you have or could have psoriatic arthritis, which involves both skin problems and joint pain, you may need to see both a rheumatologist and a dermatologist (skin specialist).

Reasons You May See a Rheumatologist

Most of the time, muscle aches, pains, or injuries aren't serious. But if your joints hurt, and especially if you have signs of inflammation that don't go away after a day or two, you may need to see a healthcare provider. 

Symptoms of inflammation include:

• Redness
• Swelling
• Pain
• Stiffness
• Loss of joint function

Usually, in order to see a rheumatologist, you need to get a referral from your primary care provider. They may refer you when:

• There is no evidence of a back injury
• Attempts to treat you with at-home therapies (like heat application), prescription medications, or physical therapy haven't been successful
• They're uncertain what's causing your back pain but suspect it's something rheumatological
• Blood tests for inflammatory markers or certain antibodies (immune-system cells) yield abnormal results
• They've diagnosed you with a rheumatic condition and want a specialist to manage it
  
• You have a family history of a rheumatic or autoimmune condition that may cause back pain
• You have a chronic pain condition and later develop back pain

You may also be sent to a rheumatologist if your back pain is accompanied by:

• Skin rashes
• Fever
• Fatigue
• Pain in multiple parts of your body
• Red, swollen joints
• Pain and inflammation that come and go
• Fingers that turn blue or ache when exposed to the cold
• Unexplained weight changes
• Dry eyes and mouth
  

Some types of arthritis can cause permanent, progressive joint damage. It's best to see a rheumatologist as soon as possible if your primary care provider suspects one of these diseases, as early diagnosis and treatment are the best way to prevent this damage.

Conditions Rheumatologists Treat

Many conditions can affect the spine and cause back pain. Not all of them are treated by a rheumatologist. Those that are include:

Rheumatoid arthritis (RA): This often starts in smaller joints of the hands and feet and later moves to the neck and/or back. It may also affect different body organs and have systemic symptoms.

Ankylosing spondylitis (AS): Primarily a disease of the spine, AS may also impact the shoulders, hips, knees, and ankles. Systemic symptoms, including fever and fatigue, are possible.

Axial spondylitis: This primarily affects the spine, chest, and pelvis. It may also cause problems in the eyes, bowel, skin, and connective tissues.

Psoriatic arthritis (PsA): Pain in the lower back (lumbar spine) is common, especially in severe cases of PsA. It can affect other joints and causes psoriasis (a skin disease).

Reactive arthritis: This is a reaction to infection. It can involve the spine, but is more common in the joints of the limbs, hands, and feet.

Enteropathic arthritis: This mainly affects the spine but can include other joints. It's associated with inflammatory bowel disease.

Many autoimmune diseases that don't specifically target the spine can cause back pain, as well. These include:

• Lupus
• Sjögren's syndrome
• Hashimoto's thyroiditis

Fibromyalgia isn't classified as inflammatory or autoimmune, but it's associated with back pain as well.

Rheumatologists treat all of these conditions.

Orthopedist or Rheumatologist?

When the cause of your back pain is or seems to be unrelated to issues like these, you may need an orthopedist instead of a rheumatologist. Orthopedists and orthopedic surgeons specialize in treating and preventing problems with the bones, joints, muscles, and connective tissues.

Orthopedists and rheumatologists have some overlap in what they treat. For example, they may both treat RA, osteoporosis, and certain injuries. But orthopedists treat many causes of back pain that rheumatologists don't, including:

• Scoliosis
• Bone spurs
• Spinal fractures
• Many back injuries

An orthopedist is also necessary if you need surgery, such as joint replacement.

Your primary care provider may initially make this decision based on your symptoms, medical history, physical examination, and possibly diagnostic testing. Or, it's possible that you may be referred to an orthopedist if a rheumatologist evaluates you and sees the need.

For some problems, such as RA requiring joint replacement, you may see both an orthopedist and rheumatologist.

Finding a Rheumatologist

When it comes to which rheumatologist to see, you may be happy to accept whoever your primary healthcare provider refers you to. But you may want to research the options in your area to make sure you get the right rheumatologist for you.

• Be sure to check on which doctors your health insurance covers.
• Ask members of your healthcare team, friends, and family for recommendations.
• Search online directories such as the one on The American College of Rheumatology website.
• Visit the websites of the doctors you are considering to learn more about their training, approach, and niche specialties.
• Check online reviews.
• Contact rheumatologists' offices to see who is accepting new patients.

Once you've made a decision, pass along the information to your primary care doctor so they can put in a referral for you.

Preparing for Your Visit

Before you see your new rheumatologist, take a few minutes to prepare so you can make the most of your appointment. You'll want to have:

• A list of back-related symptoms, including how frequent and severe they are
• A list of what makes your symptoms better or worse
• A copy of your recent test results and appointment records from any other doctors you've seen (you can also ask your providers to send this information to the rheumatologist's office in advance)
• A list of treatments you've tried and how well they've worked
• A list of all the medications (prescription and over-the-counter), supplements, and herbal products you take
• A list of drug allergies
• Your complete medical history and family history of potentially related diseases
• A list of questions you have

If you have the option, fill out any paperwork for the new office ahead of time. That can save time on the day of your appointment.

Summary

Severe or persistent back pain is often treated by a rheumatologist or an orthopedic surgeon. A rheumatologist is an expert in autoimmune diseases such as rheumatoid arthritis and ankylosing spondylitis, whereas orthopedists treat joint and muscle injuries and osteoarthritis.

You should see a rheumatologist if you have back pain that's not from an injury and doesn't go away in a few days, pain that comes back after treatment, or symptoms that suggest a rheumatic condition. You may need to first see your primary care provider for a referral.

Common autoimmune diseases that impact the spin include RA, AS, axial spondylitis, PsA, and other forms of inflammatory or autoimmune arthritis.