Rheumatologist

What is a rheumatologist?

A rheumatologist is an internal medicine physician with specialized training in rheumatology. This medical specialty deals with degenerative, autoimmune and inflammatory diseases that affect your musculoskeletal system. Many of these conditions are lifelong, and they can run in families. Rheumatologists help people manage musculoskeletal pain and repress chronic inflammation.

What is rheumatology?

Rheumatology is the study of rheumatic diseases. These are mostly chronic inflammatory conditions that affect your connective tissues — like your bones, joints, muscles, tendons and ligaments. Many rheumatic diseases are autoimmune disorders, like inflammatory arthritis. Others are musculoskeletal conditions that started with an injury and turned into a chronic disorder when the injury didn’t heal.

What does a rheumatologist do?

Rheumatologists diagnose and treat complex conditions affecting your musculoskeletal system and connective tissues. These diseases are more complicated than a simple injury or mechanical problem.

Types of rheumatic diseases include:

• Autoimmune diseases that cause your immune system to attack your own tissues.
• Connective tissue diseases that affect supporting structures throughout your body.
• Inflammatory disorders or infections that affect your muscles, joints or bones.

Diagnosing these conditions involves looking at blood tests and imaging studies. Treating them often involves a multipronged approach, which might include medications, injections and physical therapy.

What diseases and conditions do rheumatologists treat?

Some of the diseases and conditions rheumatologists treat include:

• Ankylosing spondylitis.
• Beçhet’s disease.
• Bursitis.
• Charcot-Marie-Tooth disease.
• Gout.
• Myopathies.
• Osteoarthritis.
• Polymyositis.
• Psoriatic arthritis.
• Rheumatic fever.
• Rheumatoid arthritis.
• Sarcoidosis.
• Scleroderma.
• Sjögren’s syndrome.
• Systemic lupus erythematosus.
• Vasculitis.

What type of medical training does a rheumatologist have?

Training to become a rheumatologist starts with a traditional bachelor’s degree, followed by a four-year medical school curriculum. This may mean a doctor of medicine degree (MD) or a doctor of osteopathy degree (DO). After medical school, physicians complete a three-year medical residency. A future rheumatologist must complete their residency in either internal medicine or pediatrics (or both).

During their residency, doctors gain experience managing a broad range of internal diseases. When it’s complete, they must pass a board examination in internal medicine or pediatrics in order to continue their education. Then, they must enroll in a two- to three-year fellowship program specializing in rheumatology. This gives them specific training in musculoskeletal and autoimmune diseases.

Rheumatologists become board-certified after passing a rigorous exam demonstrating their knowledge. Once they’re certified, they must stay current in their training through continuing medical education (CME) courses to maintain their medical license. A continuing education program called Maintenance of Certification (MOC) is one way to do this. Participating doctors are designated as “participating in MOC.”

Why would you go to a rheumatologist?

One reason to see a rheumatologist is if you have a family history of rheumatic or autoimmune disease. These diseases can be hereditary, and screening can help catch them sooner. If you develop symptoms that suggest a rheumatic disease, your primary care provider might refer you to a rheumatologist. These symptoms can be wide-ranging, but they have some common features your provider might recognize. 

Rheumatic diseases can:

• Happen in many places at once or all over your body.
• Affect many types of tissues, like your muscles, veins and skin.
• Make your tissues feel sore, stiff or swollen.
• Also cause systemic symptoms, like fever and fatigue.

When should I see a rheumatologist?

If you or your primary care provider suspect you might have a rheumatic disease, you should see a specialist as soon as possible. This is especially true if your symptoms come on suddenly or worsen quickly. Many rheumatic diseases are progressive, meaning they worsen over time, affecting more tissues and causing more symptoms. As they progress, some can do permanent damage to your tissues.

How should I prepare to see a rheumatologist?

You can prepare for your appointment by:

• Organizing your records. A rheumatologist will want to see notes and test results from previous doctors you’ve visited. You may have copies of these or you may need to request them.
• Documenting your medical history. Your doctor will want to know what medications, vitamins or supplements you’re taking. They may also ask about previous conditions and prescriptions.
• Keeping a symptom journal. Rheumatic diseases can cause a variety of symptoms, and they can change quickly. Writing them down is helpful for keeping track of the details.
• Planning to take notes. During your first visit, you might be confronted with a lot of new information. It can be overwhelming. It can help to bring a friend who can help you take notes.

What types of tests do rheumatologists use to make diagnoses?

In addition to a physical exam, your rheumatologist might order various diagnostic tests, including:

• Blood tests.
• Imaging tests, like X-ray, ultrasound, CT scan or MRI.
• Bone density test (DEXA scan).
• Tissue biopsy.
• Electromyogram.
• Organ function tests.

How do rheumatologists treat rheumatic diseases?

Treating rheumatic diseases is complex. Rheumatologists use many different methods, depending on your symptoms and how they respond. Your treatment plan will be personal to you. It may include:

• Corticosteroids.
• Immunosuppressants.
• Disease-modifying antirheumatic drugs (DMARDs).
• Joint injections.
• Orthotics.
• Physical therapy.
• Occupational therapy.
• Referrals to an orthopaedic surgeon.

Your care will likely include ongoing regular testing and monitoring. Many inflammatory conditions can progress over time or cause new complications, requiring your rheumatologist to reassess your treatment plan. Rheumatologists try to stay ahead of these changes by seeing you regularly. These frequent touchpoints make it easier to adjust your therapy before you experience discomfort.