What is a Rheumatologist?

Rheumatologists specialize in the diagnosis, treatment, and therapy of rheumatic diseases and focus on conditions involving joints, connective tissues, and autoimmune diseases. Rheumatic diseases are disorders that affect the immune system. Along with affecting the health and function of the joints, muscles, bones; rheumatic disorders can also affect organs including the kidneys, lungs, and brain.

A rheumatologist analyzes patient records, tests, and examinations to assess those suffering from rheumatic diseases involving physical aspects such as joint dysfunction as well as mental health.

Treatments provided by a Rheumatologist can range from referral to other medical specialists and the use of orthopedic aids such as supportive splints and/or braces, use of a cane, or even require corrective surgery.

Conditions also treated by Rheumatologists include rheumatic heart disease and other rheumatologic disorders such as rheumatoid arthritis, gout, and lupus. Some other common rheumatic disorders requiring specialist treatment from a Rheumatologist include chronic back pain as well as pain in the shoulder, wrist, biceps, leg, knee, ankle, hip, and Achilles, bursitis, tendinitis, and osteoarthritis. Rheumatism is a disorder that affects the locomotor system including joints, muscles, connective tissues, soft tissues around the joints, and bones. 

Rheumatologists may work in conjunction with related disciplines including Immunologists, Orthopedics, and Pain Management doctors.

What kind of training do rheumatologists have?

After four years of medical school and three years of training in either internal medicine or pediatrics, rheumatologists devote an additional two to three years in specialized rheumatology training. 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.

What do rheumatologists treat?

There are more than 100 types of rheumatic diseases, including:

  • osteoarthritis
  • rheumatoid arthritis
  • musculoskeletal pain disorders
  • osteoporosis
  • gout
  • back pain
  • myositis
  • fibromyalgia
  • tendonitis
  • vasculitis
  • certain autoimmune diseases, such as lupus, antiphospholipid syndrome, scleroderma

When should I see a rheumatologist?

Everyone experiences muscle and joint pain from time to time. When the muscle and joint pain is not resolving as one would expect, additional evaluation may be needed. Typically, the primary care physician is seen for the first evaluation. If there is a concern for an underlying rheumatic condition, he/she will refer you to rheumatology for evaluation.

Earlier referral should be made if you have relatives with an autoimmune or rheumatic disease (as these conditions run in families) or if the symptoms are significantly worsening over a short period of time. Some of the signs and symptoms can improve or temporarily resolve when initially treated but can return once the medication is stopped. If the symptoms continue to return, a rheumatology evaluation may be needed. Although treatment should not be delayed while awaiting a rheumatology appointment, certain medications can improve symptoms and make a diagnosis more difficult.

Joint damage can occur if the symptoms of joint pain are ignored or not treated properly over a period of time. This damage cannot always be reversed with treatment and may be permanent. Do not delay appropriate evaluation.

What should I expect from my rheumatology visit?

Rheumatic diseases are sometimes complex in nature and difficult to diagnose, so rheumatologists will gather a complete medical history and perform a physical exam to look for signs and symptoms of inflammation throughout the entire body and musculoskeletal system. Family history can be very important to the diagnosis of rheumatic disease and will also be assessed.

The rheumatologist will review the results of any prior testing that has been performed on a patient and may order additional laboratory tests to assess inflammation and/or extra antibody production within the bloodstream and order radiographic testing (X-ray, ultrasound, CT scan or MRI) to assess for musculoskeletal abnormalities.

All of these results will be combined to determine the source of a patient’s symptoms and develop a personalized treatment plan. Treatment recommendations may include medications, referral to physical therapy, referral to other specialists, or joint/tendon injections. Some rheumatic diseases can be difficult to diagnose and may require several visits for the rheumatologist to fully understand the underlying process.

During follow-up appointments, rheumatologists may treat reoccurring conditions or talk with patients about medications, coping mechanisms, techniques for preventing disability or regaining function, and ways to improve their quality of life.

What should I bring to my first rheumatology visit?

Please bring the following to your first rheumatology visit:

  • Any previous lab and/or radiographic X-ray/ultrasound/MRI tests results for review (medical records are typically sent by the referring physician, but occasionally – despite best intentions – are not present. Sometimes tests need to be repeated to confirm the result)
  • An up-to-date medication list with the specific dosages you are taking (include a list of medications you have already tried to reduce duplication of prior treatments)
  • A list of allergies to medications
  • Your family history, including any known relatives with rheumatologic/autoimmune disease

Is specialty care more expensive?

Typically, the insurance co-pay is higher to see a specialist than a primary care physician. You may be surprised to learn that specialized care may save time and money in the long-term, as well as reduce the severity of the disease. A rheumatologist has special training to spot clues in the history and physical exam that can lead to earlier diagnosis and is knowledgeable about testing that may reduce unnecessary procedures and save you money.

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