People may need to see a rheumatologist if they experience persistent joint pain or stiffness.
In this article, we discuss what rheumatologists do, the types of conditions they treat, the procedures they perform, and why someone would need to see one.
What is a rheumatologist?
Rheumatologists help people with musculoskeletal conditions, among others.
A rheumatologist is an internal medicine doctor who specializes in diagnosing and treating inflammatory conditions that affect the joints, tendons, ligaments, bones, and muscles.
Rheumatologists diagnose and treat musculoskeletal conditions, but they do not perform surgery.
Before they can start treating these conditions, a rheumatologist must fulfill the following education and training requirements, according to the American College of Rheumatology:
- graduate from a medical school
- complete a residency program
- participate in a rheumatology fellowship
After a person finishes a rheumatology fellowship program, they must pass a board examination and receive their certificate to practice rheumatology. Rheumatologists must participate in continuing education courses throughout their careers.
A rheumatologist can choose to treat specific rheumatic conditions, or they can narrow their focus to a particular area, or subspecialty, within rheumatology.
Subspecialties in the field of rheumatology include:
- autoimmune and inflammatory conditions
- noninflammatory degenerative joint conditions
- soft tissue diseases
- chronic pain
- metabolic disorders that affect the bone
- pediatric or juvenile rheumatic conditions
What conditions do they diagnose and treat?
Rheumatologists can treat autoimmune and inflammatory conditions that affect the joints, tendons, ligaments, bones, muscles, and blood vessels (vasculitis).
These conditions include:
- inflammatory arthritis of the knees, hips, or shoulders
- rheumatoid arthritis
- psoriatic arthritis
- systemic lupus erythematosus (lupus)
- giant cell arteritis
- Behcet’s disease
- polymyalgia rheumatica
- Paget’s disease
- ankylosing spondylitis
- Reiter’s syndrome
- reactive arthropathies (secondary to bowel disorders, skin disease, or infections)
- Sjogren’s syndrome
- idiopathic juvenile arthritis
What procedures do they perform?
Rheumatologists perform examinations and procedures that help them diagnose and treat rheumatic conditions.
These procedures include:
A rheumatologist usually performs a complete physical exam when they see a person for the first time, or when they want to monitor the effects of a current treatment program.
During a physical exam, a rheumatologist will assess the person’s overall physical condition by checking their pulse, listening to their lungs and hearts, and feeling for swollen lymph nodes.
They will spend extra time examining areas where people report feeling pain or stiffness. They might ask a person to bend, flex, or stretch these areas. They will also examine joints on both sides of the body to compare size, intensity of inflammation, range of motion, and function.
People with arthritis can experience symptoms in one or more joints on one side of the body, while others may notice pain and stiffness in one or more joints on both sides of the body.
A rheumatologist will also review a person’s medical history, current medical conditions, and family history during this comprehensive interview.
Rheumatologists diagnose systemic inflammatory diseases and musculoskeletal conditions. They use a variety of tests to identify the underlying cause of a person’s symptoms.
Some potential causes of inflammation include:
- environmental exposures
- autoimmune conditions
- abnormal uric acid metabolism
A rheumatologist can also diagnose conditions that cause bone or cartilage loss, including osteoporosis and osteoarthritis.
A rheumatologist may perform imaging tests to look for signs of joint damage.
A primary care doctor or rheumatologist can use different imaging tests to look for signs of joint damage. Some imaging tests they may conduct include:
Laboratory testing involves taking samples of blood, urine, or joint fluid and sending these samples to a laboratory for further analysis.
A rheumatologist can use lab test results to identify signs of inflammation and infections, such as higher-than-normal levels of inflammatory compounds, antibodies, or white blood cells.
They can also use these test results to look for specific genetic markers that may increase a person’s risk of specific autoimmune or inflammatory conditions.
For instance, according to the American College of Rheumatology, around 60–70% of people with European ancestry and rheumatoid arthritis carry a gene called HLA-DR4, which is linked to the immune system.
In recent years, researchers have also discovered several genetic markers associated with ankylosing spondylitis. These include HLA-B27, ARTS 1, and IL23R.
Treating rheumatic conditions
Rheumatologists can suggest and provide treatments for many rheumatic conditions. They can also offer consultation on many cases.
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Treatments they may recommend include:
Joint injections and aspirations
A rheumatologist can treat joint inflammation and pain by either injecting an anti-inflammatory medication, such as corticosteroid, directly into the affected joint or by aspirating the joint.
When a rheumatologist aspirates a joint, they use a needle attached to a syringe to remove excess joint fluid. They use joint aspiration to reduce patients’ joint swelling and pain and to analyze the joint fluid as a part of the diagnostic protocol.
A rheumatologist might prescribe disease modifying antirheumatic drugs, which lower immune system activity or slow down the progress of rheumatic conditions.
Nonsteroidal anti-inflammatory drugs — such as ibuprofen, naproxen, meloxicam, and aspirin — can also help relieve joint inflammation and reduce pain in the joints.
What to expect during a routine visit
A routine appointment with a rheumatologist varies depending on the condition or complaint they are helping treat. A standard appointment may include the rheumatologist:
- reviewing a person’s medical and family histories as well as the results of any previous testing or laboratory work
- performing a physical exam to look for any signs of systemic inflammation
- specifically examining any joints, muscles, or bones that feel swollen, stiff, or painful
- ordering blood work or other laboratory tests, such as an X-ray or an MRI scan
- making treatment recommendations, or waiting to review the lab work before recommending medications or physical therapy
When to see a rheumatologist
If pain or stiffness is chronic, a primary care doctor may refer someone to a rheumatologist.
Many people experience joint and muscle pain from time to time. However, people who notice pain or stiffness that does not improve within a few weeks may want to consider visiting their primary care doctor.
A primary care doctor will evaluate a person’s symptoms and decide whether or not they should refer them to a rheumatologist for further evaluation.
A primary care doctor may refer someone to a rheumatologist when:
- they have made a diagnosis of or suspect that a person has a systemic inflammatory condition, and they want a second opinion
- a person has symptoms of rheumatism and a family history of rheumatic disease
- a person’s symptoms improve after treatment but return if they stop taking medication
- a person’s symptoms do not respond to treatment or worsen over time
- a person develops unexpected complications, such as unexplained fever, rash, or fatigue
- a person has unusual laboratory test results
Rheumatologists are medical doctors who specialize in diagnosing and treating rheumatic diseases, including arthritis and autoimmune conditions.
The Centers for Disease Control and Prevention (CDC) report that in 2013–2015, 54.4 million adults in the United States had ever received a diagnosis of some type of arthritis. The prevalence is higher in females (23.5%) than males (18.1%) and increases with age.
A rheumatologist can diagnose rheumatic conditions by taking a comprehensive medical history, performing a complete physical exam, and examining laboratory and imaging test results.
They can also perform a variety of procedures — including lumbar punctures, bursal injections, joint injections, and joint aspiration — to help diagnose and treat joint conditions.
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