Role of the Rheumatologist in the Management of Rheumatic Diseases
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 potentially cause joint deformities.
What does the rheumatologist do?
Autoimmune conditions occur when the immune system causes inflammation in areas of the body where it is not needed, causing damage/symptoms. These diseases can also affect the eyes, skin, nervous system, and internal organs. While the role of an orthopedic surgeon is to perform surgery on bones and joints (the musculoskeletal system), the role of the rheumatologist is to diagnose what type of musculoskeletal disease a person has and to treat it using nonsurgical methods. Many rheumatologists also conduct research to look for the causes of and better treatments for rheumatic diseases. Although there are more than 100 different types of arthritis and musculoskeletal conditions, common diseases treated by rheumatologists include:
Where does the rheumatologist work?
Rheumatologists work mainly in outpatient clinics. Primary care providers or other physicians can refer you to a rheumatologist for evaluation. Many rheumatologists do not require a referral from another physician for appointments to be made. Some rheumatologists are affiliated with a hospital and will be asked to evaluate patients who are hospitalized for rheumatologic problems.
What kind of training do rheumatologists have?
Rheumatologists must complete three to 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 internal medicine and pediatrics. A rheumatologist who completes medical school uses the initials M.D. (medical doctor) after his/her name, while a rheumatologist who finishes osteopathic school uses the initials D.O. (doctor of osteopathy). However, both types of doctors receive very similar training, and both are similar in their expertise and care. After residency, they must enroll in a rheumatology fellowship for two to three years to specialize in diagnosing and treating musculoskeletal and autoimmune conditions.
Most rheumatologists then take an examination that tests their knowledge of rheumatology (called a board examination). Rheumatologists who pass this exam are noted to be “board certified.” Many rheumatologists then decide to participate in a voluntary program coordinated by the American Board of Medical Specialties called Maintenance of Certification (MOC). Physicians who participate in this program do so to show that they are pursuing better healthcare for their patients, demonstrating advanced knowledge, and committing to lifelong learning in the specialty of rheumatology. Rheumatologists who successfully participate in and meet the requirements of MOC are designated as “participating in MOC.” To find out if a rheumatologist is board certified and participating in MOC, visit the American Board of Medical Specialties, the American Board of Internal Medicine, or the American Board of Pediatrics. Note: A rheumatologist is not required to be board certified nor to participate in MOC in order to practice medicine as a rheumatologist. However, having these designations demonstrates additional motivation and work on the rheumatologist’s part to strive to be the best rheumatologist he or she can be. To maintain a medical license, rheumatologists must participate in classes or studies that cover current medical practices. These courses are called continuing medical education or CME.
What should I expect from my rheumatology visit?
Rheumatic diseases are sometimes complex and difficult to diagnose, so rheumatologists will gather a complete medical history and perform a physical exam to look for signs and symptoms that may give clues to the cause of the problem. Family history can be very important in diagnosing rheumatic diseases. Your rheumatologist will want to know as much about your family history as possible.
The rheumatologist will review the results of any prior testing. The rheumatologist may order additional laboratory tests, imaging studies (X-ray, ultrasound, CT scan or MRI), or other tests to assess for additional potential clues to the possible cause of your musculoskeletal problem.
All of these results will be combined to determine the source of a patient’s symptoms and develop a personalized treatment plan. Some rheumatic diseases can be difficult to diagnose and may require several visits with your rheumatologist. Treatment recommendations may include:
- Referral to physical or occupational therapy
- Referral to other specialists
- Joint/tendon injections
During follow-up appointments, rheumatologists may treat reoccurring conditions or talk with patients about medications, coping mechanisms, techniques for preventing disability or regaining function, and ways to improve their quality of life.
What should I bring to my first rheumatology office visit?
The following should accompany you to your first rheumatology visit:
- Any previous labs, radiographic X-ray/ultrasound/MRI tests results, and doctors’ notes for review. The referring physician sometimes sends medical records, but not always. It is important that you ensure that as much information is available to the rheumatologist on your first visit as possible.
- An up-to-date medication list with the specific dosages you are taking. Also include a list of medications you have already tried (to reduce duplication of prior treatments).
- A list of allergies and intolerances to medications.
- Your family history, including any known relatives with rheumatologic/autoimmune disease. Find out and list all aspects of family history, no matter how trivial you feel it may be.
- A list of all previous medical problems, surgeries, travel history, sleep habits, diet, exercise, and social history (e.g., education, occupation, sports, use of illicit drugs, etc.).
Is specialty care more expensive?
Typically, the insurance co-pay is higher to see a specialist than a primary care physician. You may be surprised to learn that specialized care may save time and money in the long-term, as well as reduce the severity of the disease. A rheumatologist has special training to spot clues in the history, physical exam, and test results that can lead to earlier diagnosis. The rheumatologist is knowledgeable about testing that may reduce unnecessary procedures and save you money.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.