A rheumatologist is an internist or pediatrician who received further training in the diagnosis (detection) and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic diseases. These diseases can affect the joints, muscles, and bones causing pain, swelling, stiffness, and deformity.
Autoimmune conditions occur when the immune system sends inflammation to areas of the body when it is not needed causing damage/symptoms. These diseases can also affect the eyes, skin, nervous system, and internal organs. Rheumatologists treat joint disease similar to orthopedists but do not perform surgeries. Common diseases treated by rheumatologists include osteoarthritis, gout, rheumatoid arthritis, chronic back pain, tendinitis, and lupus.
Many rheumatologists also conduct research to find a cause of and better treatment of a rheumatic disease.
How is a rheumatologist trained?
Rheumatologists must complete 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. After residency, they must enroll in a rheumatology fellowship for two – three years to learn about chronic musculoskeletal and autoimmune conditions and their treatment.
Rheumatologists then take a board examination to become board certified in rheumatology. This certification/exam has to be retaken every ten years. Physicians are also required to participate in a certain amount of continuing medical education on a yearly basis.
Where do rheumatologists work?
Rheumatologists work mainly in outpatient clinics. Primary care providers or other physicians can refer you to a rheumatologist for an evaluation. Some rheumatologists do not require a referral from another physician for appointments to be made. Rheumatologists are typically affiliated with a hospital and will be asked to evaluate patients who are hospitalized for a rheumatic disease.
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 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 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.