What is a Rheumatologist?

Doctor smiling

A rheumatologist is an internist or pediatrician who received further training in the diagnosis (detection), and treatment of diseases that affect the muscles, bones, joints, ligaments, and tendons. These diseases can cause pain, swelling, stiffness, and potentially cause joint deformities. An old-fashioned word for these problems is “rheumatism.” Therefore, a “rheumatologist” is the doctor that treats rheumatism.

Rheumatologists also treat a group of diseases called “systemic autoimmune diseases.” Other terms that you may hear or read that mean the same as systemic autoimmune diseases are “collagen vascular diseases,” and “connective tissue diseases.” This is a group of diseases where a person’s immune system attacks the person’s own body. This ends up causing inflammation in areas of the body where it is not needed, causing problems such as pain, swelling, and organ damage. These diseases can affect any part of the body to include the eyes, skin, nerves, kidneys, lungs, heart, and other internal organs. All the systemic autoimmune diseases can cause inflammation of the joints, or arthritis. Therefore, rheumatologists are considered the experts in treating this group of disorders. Some examples of systemic autoimmune diseases include rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s disease, scleroderma, polymyositis, and vasculitis. However, there are more than 100 different types of arthritis and musculoskeletal conditions. Many rheumatologists also conduct research to look for the causes of and better treatments for rheumatic diseases.

While the role of an orthopedic surgeon is to perform surgery on bones and joints (the musculoskeletal system), the purpose of the rheumatologist is to diagnose what type of musculoskeletal disease a person has and to treat it using nonsurgical methods.

How is a rheumatologist trained?

Rheumatologists must complete three to four years of medical or osteopathic education, followed by three years of residency training in either internal medicine or pediatrics. Some rheumatologists are trained in both internal medicine and pediatrics. A rheumatologist who completes medical school uses the initials MD (medical doctor) after his/her name, while a rheumatologist who finishes osteopathic school uses the initials DO (doctor of osteopathy). However, both types of doctors receive similar training, and both are similar in their expertise and care. After residency, they must participate in a rheumatology fellowship for two to three years to specialize in diagnosing and treating musculoskeletal and autoimmune conditions.

Most rheumatologists then take an examination that tests their knowledge of rheumatology (called a board examination). Rheumatologists who pass this exam are noted to be “board certified.” Many rheumatologists then decide to participate in a voluntary program coordinated by the American Board of Medical Specialties called Maintenance of Certification (MOC). Physicians who participate in this program do so to show that they are pursuing better healthcare for their patients, demonstrating advanced knowledge, and committing to lifelong learning in the specialty of rheumatology. Rheumatologists who successfully participate in and meet the requirements of MOC are designated as “participating in MOC.” To find out if a rheumatologist is board certified and participating in MOC, you can go to www.abms.org, www.abim.org, or www.abp.org.

Note, a rheumatologist is not required to be board certified nor to participate in MOC to practice medicine as a rheumatologist. However, having these designations demonstrates additional motivation and work on the rheumatologist’s part to strive to be the best rheumatologist he or she can be. To maintain a medical license, rheumatologists must participate in classes or studies that cover current medical practices. These courses are called continuing medical education or CME for short.

Note that the above information regarding MD, DO, board certified, and MOC pertain to rheumatologists who practice in the United States of America. Other countries have their own, unique professional designations.

Where do rheumatologists work?

Rheumatologists work mainly in outpatient clinics. Primary care providers or other physicians can refer you to a rheumatologist for evaluation. Many rheumatologists do not require a referral from another physician for appointments to be made. Some rheumatologists are affiliated with a hospital and evaluate patients who are hospitalized for rheumatologic problems.

When should I see a rheumatologist?

Most everyone experiences muscle, bone, or joint pain from time to time. When the pain does not resolve as one would expect, additional evaluation may be needed. Typically, a primary care, urgent care, or an emergency room provider (physician, nurse practitioner, or physician assistant) is seen for the first evaluation. If there is a concern for an underlying rheumatic condition, he/she may refer you to rheumatology for evaluation. Occasionally, other health care providers such as physical therapists, occupational therapists, chiropractors, orthopedic surgeons, or other medical specialists may recommend that you see a rheumatologist.

You should consider seeing a rheumatologist earlier if you have relatives with an autoimmune or rheumatic disease (as these conditions often run in families) or if the symptoms are significantly worsening over a short period. Some of the signs and symptoms can improve or temporarily resolve when initially treated, but they can occasionally recur after you stop treatment. If the symptoms continue to return, a rheumatology evaluation may be needed.

Joint damage may potentially occur in some rheumatic diseases. Therefore, it is essential to see a rheumatologist sooner than later. In many diseases, such as rheumatoid arthritis and psoriatic arthritis, quicker diagnosis and treatment can prevent permanent damage to the joints. 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 and challenging to diagnose. So, a rheumatologist will gather a complete medical history and perform a physical exam to look for signs and symptoms that may give clues to the cause of the problem. Your family history can be helpful in diagnosing rheumatic diseases. Your rheumatologist will want to know as much about your family history as possible.

The rheumatologist will review the results of any prior testing. The rheumatologist may order additional laboratory tests, imaging studies (X-ray, ultrasound, CT scan, MRI), or other tests to assess for additional potential clues to the possible cause of your musculoskeletal problem.

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 or occupational therapy, referral to other specialists, or to perform joint/tendon injections. Some rheumatic diseases can be challenging to diagnose and may require several visits with your rheumatologist.

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 labs, radiographic X-ray/ultrasound/MRI tests results, and doctors’ notes for review. Don’t assume that your referring physician will send your medical records. It is vital that you ensure that as much information is available to the rheumatologist on your first visit as possible.
  • 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 and intolerances to medications.
  • Your family history, including any known relatives with rheumatologic/autoimmune disease. Find out and list all aspects of family history, no matter how trivial you feel it may be.
  • A list of all previous medical problems, surgeries, travel history, sleep habits, diet, exercise, and social history (education, occupation, sports, and the use of illicit drugs, for example).

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 specialized training to spot clues in the history, physical exam, and test results that can lead to earlier diagnosis. The rheumatologist is knowledgeable about testing that may reduce unnecessary procedures and save you money.

Updated May 2021 by Don Thomas, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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