When to See a Rheumatologist for Your Back Pain

Back pain is a common reason for people to go to the healthcare provider. But what type of healthcare provider is best for your back pain?

Often, the answer is a rheumatologist. They're board-certified MDs who specialize in diseases of the joints. Or, in other words, most types of arthritis.

However, sometimes the answer is an orthopedist. They're considered the top experts on osteoarthritis. That's the most common type and features wear-and-tear damage.

Rheumatologists generally focus on systemic, autoimmune, and inflammatory forms of arthritis.

Rheumatologists and orthopedists treat joint diseases in similar ways. But rheumatologists don’t perform surgery and many orthopedists do (depending on their specialty).

This article looks at rheumatic diseases that cause back pain, when you should see a rheumatologist, and the differences between rheumatologists and orthopedists.

Medical consultation
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Rheumatic Disease Facts

Joint diseases affect:

  • 54.4 million people in the United States, 11 million of whom have a rheumatic disease
  • Almost 300,000 American children
  • People of all ages, races, and genders

Rheumatic Diseases and the Spine

Rheumatic diseases that affect the spine can be very difficult to live with. These include:

  • Rheumatoid arthritis (RA): Often starts in smaller joints of the hands and feet and later moves to the neck and/or back. May also strike organs and have systemic symptoms.
  • Ankylosing spondylitis (AS): Primarily a disease of the spine, may also impact the shoulders, hips, knees, and ankles. Systemic symptoms including fever and fatigue are possible.
  • Axial spondylitis: Primarily affects the spine, chest, and pelvis. 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. Can affect other joints and causes psoriasis (a skin disease.)
  • Reactive arthritis: A reaction to infection. Can involve the spine but is more common in the joints of the limbs, hands, and feet.
  • Enteropathic arthritis: Mainly affects the spine but can include other joints. Associated with inflammatory bowel disease.

What Is Autoimmune Disease?

An autoimmune disease involves your immune system attacking healthy tissues, cells, or substances in your body. The immune system mistakes the target for something dangerous, like a virus or bacterium, and tries to destroy it. This can lead to pain, inflammation, and a host of other symptoms that vary depending on what's being damaged.

When to 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, the journey to the rheumatologist’s office starts with an appointment with your primary care provider. If necessary, they can refer you to either a rheumatologist or an orthopedist. The decision depends on what appears to be going on.

Rheumatologist
  • Treats autoimmune diseases affecting the joints

  • Not a surgeon

  • Referral possible for pain in multiple joints, joint pain without injury, and joint pain along with back pain or systemic symptoms

  • Also treats lupus, Sjögren's syndrome, gout, fibromyalgia, scleroderma

Orthopedist
  • Treats osteoarthritis and injuries to the bones and joints

  • May be a surgeon

  • Referral possible for joint or muscle pain due to injury, progressive pain aggravated by carrying weight, joint replacement surgery

  • Also treats nerve pain, scoliosis, herniated disc, osteoporosis, sciatica, whiplash

For an injury or suspected osteoarthritis, they'll likely choose an orthopedist. If they suspect an autoimmune form of arthritis, they'll likely choose a rheumatologist.

If you have a family history of autoimmune or rheumatic disease, be sure to tell your provider. That puts you at a higher risk of developing one yourself, which may influence their referral or treatment decisions.

Your healthcare provider may opt to treat your pain rather than refer you to someone. If your pain returns once you stop taking the medication, let your provider know and ask for a referral to a rheumatologist.

Summary

Back pain is extremely common. Different types of back pain are treated by different healthcare providers: rheumatologists and orthopedists.

A rheumatologist is an expert in autoimmune diseases such as rheumatoid arthritis and ankylosing spondylitis. Orthopedists are often surgeons and treat things like joint and muscle injuries and osteoarthritis.

Common autoimmune diseases that impact the spin include RA, AS, axial spondylitis, PsA, reactive arthritis, and enteropathic arthritis.

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

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5 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.
  1. Centers for Disease Control and Prevention. Arthritis: National statistics. Updated February 7, 2018.

  2. American College of Rheumatology. Rheumatic disease in America: The proble. The impact. The answers. Updated 2013.

  3. Arthritis Foundation. Juvenile arthritis (JA).

  4. Johns Hopkins Medicine. About arthritis and other rheumatic diseases.

  5. Johns Hopkins Medicine. Spinal arthritis (arthritis in the back or neck).

Additional Reading