A rheumatologist is a doctor of internal medicine who diagnoses and treats arthritis and other diseases of the joints, muscles, and bones. This doctor treats both autoimmune and inflammatory diseases.
Autoimmune diseases happen when your immune system attacks and damages your own tissues. This attack causes inflammation (swelling and irritation) in different parts of your body. Autoimmune diseases can affect your skin, eyes, and internal organs, as well as your joints, muscles, and bones.
Your primary care doctor might refer you to a rheumatologist if you have symptoms of an autoimmune or inflammatory disease. A rheumatologist will do an exam and run some tests to find the cause of your symptoms and the best treatment plan.
What Does a Rheumatologist Do?
Most rheumatologists work in clinics, but some work at hospitals.
Rheumatologists specialize in the diagnosis and treatment of:
- Autoimmune diseases like rheumatoid arthritis and psoriatic arthritis
- Connective tissue diseases like scleroderma and lupus that affect ligaments, tendons, and skin
- Inflammatory disorders like osteoarthritis
They diagnose these conditions with lab tests and imaging tests such as X-ray scanning and magnetic resonance imaging (MRI). Rheumatologists also do research to better understand and find new treatments for bone and joint diseases.
Because these diseases can affect more than one part of your body, your rheumatologist might work with other specialists, including:
- Primary care doctor
- Dermatologist
- Eye doctor
- Cardiologist
- Physical therapist
- Occupational therapist
Since many of the diseases rheumatologists treat are chronic, they often provide long-term follow-up care for their patients.
Rheumatologist Education and Training
The first step to becoming a rheumatologist is to complete 3 to 4 years of medical school or osteopathic training. After finishing this training, the doctor will have either MD or DO initials after their name.
Next comes 3 years of medical residency to get hands-on experience in the field. Rheumatologist hopefuls can complete this residency in internal medicine or pediatrics. Some may study both types of medicine.
After residency, doctors can do a rheumatology fellowship that takes 2 to 3 years. They’ll study autoimmune diseases and musculoskeletal conditions and how to treat them.
Rheumatologists must then take an exam from the American Board of Internal Medicine. Those who pass the exam are board-certified rheumatologists.
These specialists stay up to date on techniques and retake certification exams every 10 years. Rheumatologists also need a certain number of continuing education hours every year.
Not all rheumatologists treat patients in medical offices and hospitals. Some do research. Others teach at medical schools. And some work for drug companies or the government.
What Does a Rheumatologist Treat?
Rheumatologists can treat more than 100 diseases of the joints, muscles, and bones. Some of the more common ones are:
- Rheumatoid arthritis
- Osteoporosis
- Tendinitis
- Fibromyalgia
- Gout
- Osteoarthritis
- Psoriatic arthritis
- Lupus
- Back pain
- Scleroderma
- Reactive arthritis
- Myositis
Although many doctors who practice rheumatology treat different symptoms, some focus on certain groups of people. For example, pediatric rheumatologists treat children under 18 years old because their bodies are different from those of adults.
Reasons to See a Rheumatologist
Almost everyone has some pain in their muscles or joints from time to time. But if the pain lasts for a while or it happens often, it's a good idea to visit a rheumatologist. You can talk to your primary care doctor first, who can give you their opinion on whether it's necessary.
It can be hard to diagnose some conditions in the early stages. But it’s better to see a specialist sooner rather than later. Without treatment, these diseases may lead to permanent joint damage.
It’s also good to see a rheumatologist if you have symptoms like joint swelling and pain and you have other family members with an autoimmune disease.
What to Expect at the Rheumatologist
A rheumatology visit often starts with a physical exam. Your doctor will examine your joints, muscles, and bones for signs like swelling, stiffness, and pain. They may ask you to move joints like your wrists, shoulders, or hips to see if you’ve lost any range of motion. The exam will also include a discussion of what other symptoms you have, such as a rash or fever.
The doctor will ask about your personal and family health history. They use this information to narrow down what may be causing your symptoms. Some autoimmune diseases run in families.
Many different tests help rheumatologists diagnose autoimmune and inflammatory diseases, including:
Lab tests. Your doctor may take samples of your blood, urine, or joint fluid. These lab tests can show whether you have an autoimmune disease like rheumatoid arthritis. They can also help your doctor monitor the disease once you’re on a treatment.
- Blood tests can find markers of inflammation like rheumatoid factor (RF), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Some blood tests check for genetic markers for diseases like ankylosing spondylitis and reactive arthritis.
- Joint fluid tests check for a chemical called uric acid to diagnose gout.
- A skin biopsy removes a small piece of your skin to check for lupus, vasculitis, or psoriatic arthritis.
- A muscle biopsy takes a small piece of tissue from a muscle to look for damage caused by diseases like vasculitis or polymyositis.
Imaging tests. These tests show signs of damage in your joints and other tissues:
- X-rays use high-energy rays to make pictures of your bones. These images can show signs of bone or joint damage.
- MRI scanning uses a large magnet and radio waves to take detailed pictures of your bones and muscles. It can show bone damage and inflammation from arthritis.
- Ultrasound uses sound waves to take pictures of muscles, tendons, ligaments, and cartilage. An ultrasound can show inflammation and bone damage from arthritis.
- Computed tomography (CT) is another test that can show bone damage.
- A bone density test (DEXA scan) measures how much bone you’ve lost.
If you’ve already had some of these tests, bring copies of the results to your rheumatologist.
Some treatments that a rheumatologist might recommend include:
Medicine. Corticosteroids bring down inflammation in your body, including in your joints. If you have an autoimmune disease, you may get medicine to calm your immune system so that it doesn’t attack your joints and other tissues.
Joint injections. The rheumatologist can inject medicine into the painful joint. Corticosteroids reduce pain and inflammation. Hyaluronic acid lubricates stiff joints.
Joint aspiration. Aspiration removes fluid from the joint with a needle to reduce swelling.
Physical therapy. Physical therapists teach you exercises and use other techniques to reduce pain, improve strength, and increase movement in your joints.
Occupational therapy. An occupational therapist teaches you ways to make daily activities safer and easier. They also recommend assistive devices like splints and jar openers.
If these methods don’t help enough, your rheumatologist might refer you to an orthopedic surgeon to fix or replace a damaged joint.
Many of the diseases that rheumatologists treat are chronic, which means they aren’t curable. You may need to be on treatment for many years. Because these conditions can change over time, your rheumatologist might follow up with you for many years, and make treatment changes when you need them.
Takeaways
A rheumatologist is a doctor who diagnoses and treats arthritis and other autoimmune and inflammatory diseases of the joints, muscles, and bones. They do lab tests, imaging scans, and other tests to diagnose these conditions. And they recommend treatments like medicine, joint injections, physical therapy, and occupational therapy.
Rheumatologist FAQs
What diseases fall under rheumatology?
Rheumatologists treat more than 100 rheumatic diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, and scleroderma.
Why am I being referred to a rheumatologist?
You might see a rheumatologist if you have pain, swelling, or stiffness in your bones, muscles, and joints that isn’t going away. Your primary care doctor might refer you to a rheumatologist if they suspect you have an autoimmune or inflammatory disease.
Do you see a rheumatologist for multiple sclerosis (MS)?
No. Multiple sclerosis is a disease of the nervous system – the brain and spinal cord. A neurologist diagnoses and treats nervous system diseases.