When to See a Rheumatologist for Your Back Pain

Back pain is one of the most common reasons for seeking healthcare. But what type of healthcare provider should you see for your back pain?

Usually, you would start with your primary care provider. Most of the time, they will diagnose and effectively treat your back pain. You might be advised to use at-home therapies (like using a heating pad), prescription medication, or go to physical therapy. If you have a chronic disease, injury, or if you aren't getting better, you may be referred to a rheumatologist.

Rheumatologists are physicians who specialize in diagnosing and treating certain inflammatory disorders, including inflammatory diseases of the joints, such as arthritis.

Less often, you may be referred to an orthopedist, which is an orthopedic surgeon. For example, you might need orthopedic intervention for severe osteoarthritis, a common type of arthritis caused by wear-and-tear damage.

This article helps you understand when you should see a rheumatologist for your back pain, and the differences between rheumatologists and orthopedists.

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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

Rheumatologists generally focus on managing systemic, autoimmune, and inflammatory forms of arthritis. 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. It may also affect different body 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. 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. It can affect other joints and causes psoriasis (a skin disease.)
  • Reactive arthritis: A reaction to infection. It 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. It's 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 certain proteins in your body 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 the severity and location of the inflammation.

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

Based on your symptoms, medical history, physical examination, and possibly diagnostic testing, your primary care provider may refer you to a rheumatologist or an orthopedist. For an injury or suspected osteoarthritis, you are likely to see an orthopedist. If you have an autoimmune form of arthritis, you are likely to see a rheumatologist.

Rheumatologist
  • Treats many inflammatory and autoimmune diseases

  • Treats with medication or injections

  • 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 injuries to the bones and joints

  • Treats with injections or surgery, and sometimes with medication

  • Referral possible for joint or muscle pain due to injury or pain aggravated by movement

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

There are overlaps between the type of care that rheumatologists and orthopedists provide, and you can often get care from either one for some conditions.


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.

Summary

Back pain is extremely common. Different types of back pain are treated by different healthcare providers. Most commonly, severe or persistent back pain is treated by a rheumatologist or an orthopedic surgeon.

A rheumatologist is an expert in autoimmune diseases such as rheumatoid arthritis and ankylosing spondylitis. Orthopedists treat 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).

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