If you live with a systemic autoimmune condition such as rheumatoid arthritis (RA) or lupus, your primary care physician can monitor many of your daily healthcare needs. But for more comprehensive assessments and treatments, you may need to see a rheumatologist.
Rheumatologists are doctors — internists or pediatricians — who receive special training in diagnosing and treating musculoskeletal disease and systemic autoimmune conditions like RA.
The conditions, known collectively as rheumatic diseases, can cause pain, swelling, stiffness, and deformities in your:
- supporting muscles
Rheumatologists typically have a lot of contact with a patient and spend a lot of time following an individual’s disease progression.
Once you’ve found a rheumatologist, they will:
- establish or confirm the diagnosis
- run tests to find the underlying cause of your condition and formulate a diagnosis
- suggest treatments
- follow up to ensure the treatments are working
- redesign treatments if the initial methods need tweaking
Becoming a rheumatologist requires completing 4 years of medical school training as a medical doctor or osteopath. That’s followed by 3 years as a medical resident specializing in internal medicine, pediatrics, or both.
To complete their formal education, a rheumatologist spends 2 to 3 years in a rheumatology fellowship, learning about chronic musculoskeletal and autoimmune conditions and how to treat them. Clinical or lab research may be part of their training.
Once they’ve completed the fellowship, the rheumatologist must pass an American Board of Internal Medicine certification exam.
Rheumatologists must take a recertification exam every 10 years. They’re also required to take continuing medical education classes to retain their board certification.
A rheumatologist can treat any of the more than 100 known rheumatic diseases, musculoskeletal conditions, and injuries, including:
- rheumatoid arthritis
- musculoskeletal pain disorders
- back pain
- muscle strains
- antiphospholipid syndrome
- other autoimmune disorders
A rheumatologist will:
- gather your medical and family histories
- perform a physical examination
- run specific tests
Rheumatologists commonly test people for excessive antibody production for suspected autoimmune disorders. To assess musculoskeletal problems, they may order:
This information helps them develop the proper treatment plan for you.
Treatment may include:
- injections into joints or tendons to reduce inflammation
- lifestyle management, such as diet, exercise, stress management
- referral to other specialists, such as a physical therapist
Rheumatologists can also talk with you about:
- coping mechanisms for living with conditions like RA
- preventing disability or regaining function
- improving your quality of life
- preventing disease progression
Muscle and joint pain are common, but see a primary care physician if you have pain that lasts for more than a few days.
A doctor can evaluate whether you’re experiencing temporary pain from an injury or other inflammatory causes. They can also refer you to a rheumatologist if needed.
If your pain worsens over a short time, you should see a rheumatologist.
Also, if your symptoms decrease with initial treatment, such as with pain medication, but return once the treatment stops, you might need a specialist.
You may want to see a rheumatologist if you:
- experience pain in multiple joints
- have new joint pain not related to a known injury
- have joint or muscle pain accompanied by fever, fatigue, rashes, morning stiffness, or chest pain
- have muscle pain with or without other symptoms
- are over 50 years old and have recurring headaches or muscle aches
- have a chronic illness without a unifying diagnosis
Many rheumatic conditions are hereditary, so let your doctor and rheumatologist know if you have any family history of:
- autoimmune disease
- rheumatic disease
Don’t delay seeking treatment if you have persistent joint, bone, or muscle pain. A doctor should evaluate joint stiffness that lasts more than 30 minutes, especially if it’s worse in the morning after long periods of inactivity or any joint swelling.
Rheumatic diseases can lead to permanent damage over time if not addressed promptly. Outcomes improve when these conditions are treated earlier, even for chronic and progressive diseases.
Rheumatologists and orthopedists both treat rheumatic diseases, but in different ways.
Generally, rheumatologists treat rheumatic diseases with nonsurgical interventions, whereas orthopedists perform surgeries to improve function and quality of life.
You may want to see an orthopedist if you need a joint replacement or have:
- joint or musculoskeletal pain related to an injury
- hip or knee pain that gets worse when you put weight on these joints
- severe joint pain that interferes with your daily life
- moderate or advanced arthritis in your hips or knees
- joint pain that hasn’t responded to previous treatment
A good rule of thumb: Unless you’ve experienced a traumatic injury that requires surgery, see a rheumatologist before you consult an orthopedist.
Rheumatologists specialize in treating rheumatic and autoimmune conditions such as lupus, rheumatoid arthritis (RA), gout, and fibromyalgia. They undergo extensive training and education to assess and treat people with these conditions. They can also advise on how to cope with diseases such as RA.
You should see a rheumatologist if you have chronic joint or musculoskeletal pain that does not go away on its own or reoccurs after short-term treatment.
Your primary care physician may refer you to a rheumatologist, who will work with you on your treatment and healing.
People with rheumatic diseases typically see rheumatologists rather than orthopedists unless they have an acute injury requiring surgery or a chronic condition that does not respond to nonsurgical treatment.