Rheumatologist

What is a rheumatologist?

A rheumatologist is an internal medicine physician with subspecialized training in rheumatology. This medical specialty deals with musculoskeletal conditions, as well as autoimmune and inflammatory conditions in people of all ages. Many of these conditions may run in families.

What does a rheumatologist do?

Rheumatologists diagnose, treat and manage a broad range of conditions, including:

• Inflammatory (rheumatic) disorders that affect muscles, joints and bones.
• Connective tissue diseases that affect supporting structures like your ligaments and tendons, and may involve the skin and other organs.
• Autoimmune diseases that happen when your immune system attacks healthy tissue.

What does a rheumatologist treat?

Conditions rheumatologists treat include:

Complex and inherited disorders

• Beçhet’s disease.
• Osteoporosis.
• Psoriatic arthritis.
• Rheumatic fever.
• Sarcoidosis.
• Scleroderma.
• Sjögren’s syndrome.
• Systemic lupus erythematosus.

Joint problems

• Ankylosing spondylitis.
• Bursitis.
• Gout.
• Osteoarthritis.
• Rheumatoid arthritis.

Tendon issues

• Achilles tendinitis.
• De Quervain’s tendinosis.
• Patellar tendonitis.
• Rotator cuff issues.
• Tennis elbow.

Muscle conditions

• Charcot-Marie-Tooth disease.
• Myopathies.
• Myasthenia gravis.
• Polymyositis.
• Rhabdomyolysis.

What is the difference between a rheumatologist vs. an orthopaedist?

Orthopaedists and rheumatologists specialize in conditions affecting the joints, bones, muscles, ligaments and tendons. They treat many of the same conditions, including joint pain and tendinitis. But there are a few differences between these medical specialties.

Rheumatologists consider every organ system when looking for the cause of your symptoms. An orthopaedist focuses on injuries, congenital disease and wear and tear (degenerative conditions). Also, orthopaedists perform surgery, but rheumatologists do not. While both rheumatologists and orthopaedists help diagnose and treat musculoskeletal conditions, rheumatologists have specialized training in musculoskeletal conditions of an inflammatory and autoimmune etiology.

What type of medical training do rheumatologists undergo?

Training starts with a traditional undergraduate bachelor’s degree followed by a four-year medical school curriculum (a doctor of medicine degree, or MD) or osteopathic education (a doctor of osteopathy degree, or DO). Osteopathic doctors learn a holistic approach that considers a person’s mind, body and spirit.

After medical school, physicians complete a three-year residency with a focus on internal medicine (adult medicine) and/or pediatrics (children and young adults). Doctors gain experience managing a broad range of diseases during their residency. Doctors must pass the internal medicine or pediatric board examination to subspecialize.

Doctors must complete an additional two- to three-year fellowship (subspecialty training) to become a rheumatologist. This education provides specific training in musculoskeletal and autoimmune/inflammatory diseases. Rheumatologists can become board certified after passing a rigorous exam demonstrating their knowledge. All rheumatologists must pursue ongoing training through continuing medical education courses.

What are reasons to see a rheumatologist?

One reason is a family history of rheumatic or autoimmune disease. You may also make an appointment if you have symptoms of a condition they treat. It’s especially important for symptoms that come on suddenly or worsen quickly.

Symptoms of rheumatic disease include:

• Dermatitis.
• Dry eyes.
• Dry mouth.
• Fatigue.
• Hair loss (alopecia).
• Inflammation in the lining of the lungs.
• Itching.
• Muscle weakness.
• Stiffness.
• Swelling.
• Swollen lymph nodes.

How soon should I see a rheumatologist?

It’s important not to delay seeking care. Some rheumatic diseases, like arthritis, can cause permanent joint damage. Receiving care in earlier stages lowers your risk.

How do I prepare for an appointment with a rheumatologist?

If you are a new patient, it may be a few weeks before you can get an appointment. During this time, there are steps you can take to prepare. These include:

• Organizing your records: The rheumatologist will want to see notes from previous doctors. It’s also helpful to get copies of lab and imaging test results.
• Documenting your medical history: This includes medications you are taking for other medical issues. You should also note any vitamins or supplements you are taking.
• Keeping a symptom journal: You may experience a variety of symptoms. And they can change quickly or come and go. Writing down your symptoms and how often you experience them will help you remember all the details.

What should I expect when I see a rheumatologist?

Appointments often include discussing your symptoms, personal- and family medical history and lifestyle. Rheumatologists also perform a thorough physical exam.

Your evaluation may include one or more diagnostic tests, including:

• Biopsy to test tissue for signs of autoimmune disease.
• Blood tests to check liver or kidney function.
• Bone density test (DEXA scan).
• CT scan, MRI or ultrasound to view organs and structures.
• Chest X-ray to assess lung issues.
• Heart tests, such as an electrocardiogram.
• Electromyogram, which measures nerve and muscle functioning.
• Endoscopy to evaluate gastrointestinal symptoms.

What types of treatments might I need?

There are many methods for treating rheumatic diseases. Rheumatologists develop a personalized care plan that may include:

• Corticosteroids.
• Immunosuppressive medications.
• Occupational therapy.
• Joint injections.
• Non-steroidal anti-inflammatory drugs (NSAIDs).
• Physical therapy.
• Referrals to an orthopedic surgeon to assess, repair or replace diseased joints.
• Splinting.

Your care may also include periodic testing and monitoring. Many inflammatory conditions may progress over time, 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 therapies before you experience discomfort.

A note from Cleveland Clinic

Rheumatologists treat a range of conditions that can be lifelong and complex. Many are difficult to diagnose, and some lead to permanent joint damage. That’s why it’s important to see a rheumatologist. They conduct thorough exams to pinpoint the precise cause of your symptoms. Your rheumatologist will develop a personalized care plan. They may also recommend monitoring to stay on top of changes that may signal the need for additional treatments.