What Is a Rheumatologist?

A rheumatologist is a physician who is highly specialized in diagnosing and treating rheumatic diseases. Rheumatic diseases include musculoskeletal diseases and systemic autoimmune diseases. Musculoskeletal diseases are conditions affecting bones, joints, muscles, and connective tissues. Systemic autoimmune diseases are conditions where the body’s immune system attacks itself.

What Does a Rheumatologist Do?

A rheumatologist is an internal medicine physician or pediatrician—or both—with speciality training. After completing medical school and a residency, they then have a two to three-year fellowship in rheumatology.

Rheumatology is a subspecialty of internal medicine that concentrates on diseases usually marked by inflammation. Such diseases can cause a wide range of symptoms, such as pain, swelling, and stiffness. Through physical exams, specialized testing, and targeted treatment, a rheumatologist can use their in-depth knowledge to help people regain a better quality of life. 

Something a rheumatologist won’t do is surgery. After diagnosing your condition, a rheumatologist will prescribe nonsurgical methods, such as medication and therapy, to help you manage your disease. It would be an orthopedic surgeon who would perform any surgery on your bones or joints that you may need.

What Diseases Do Rheumatologists Diagnose?

Rheumatologists diagnose and treat rheumatic diseases. Rheumatic disease is a term used to cover many conditions that impact the joints, muscles, bones, and connective tissues (musculoskeletal diseases) or that cause the immune system to attack itself (autoimmune diseases). 

The most common rheumatic diseases are osteoarthritis, when the cartilage within a joint breaks down, and rheumatoid arthritis (RA), when the body’s immune system attacks joint tissue. A rheumatologist can diagnose and treat both of these conditions.

There are well over 100 rheumatic diseases. Just some of the other conditions a rheumatologist can diagnose and treat are:

• Ankylosing spondylitis: This is a type of arthritis that causes stiffness in the spine due to inflammation of the spine’s joints and tissues. Over time, the inflammation can lead to the spinal bones fusing together, which means it’d be hard to move your back.
• Gout: A type of inflammatory arthritis that causes severe flares of pain, usually beginning in your big toe. Gout develops from high levels of urate buildup in the body. This urate can start to form sharp needle-like crystals that lead to inflammation and pain. 
• Juvenile idiopathic arthritis (JIA): There are several types of JIA, each with its own features. Overall, JIA causes inflammation of children’s joints and other body parts that may last anywhere from a few months to an entire lifetime.
• Psoriatic arthritis (PsA): In PsA, joints and areas where tendons and ligaments attach to bones become inflamed, leading to swelling and pain. People with PsA will often also have scaly, inflamed patches on the skin of their scalp, knees, and elbows.
• Scleroderma: In this disease, the body makes too much collagen from an autoimmune response. The excess collagen creates patches of skin that are tight and hard. 
• Systemic lupus erythematosus (SLE): Commonly referred to as just lupus, SLE can cause inflammation in the entire body and can attack the skin, heart, joints, kidneys, and lungs.
• Sjogren’s syndrome: Sjogren’s is a condition where the immune system attacks the glands that create moisture in organs like the eyes and mouth. Symptoms of this disease are often dry eyes and mouth, joint and muscle pain, and fatigue. 
• Polymyalgia rheumatica: This inflammatory disorder causes pain and stiffness of the shoulders, upper arms, and neck muscles. The symptoms are usually worse in the morning, can be very severe, and will often improve with movement.
• Reactive arthritis: This condition can occur as part of the body response to a bacterial infection. The symptoms are inflammation of the eyes, joints, and urinary tract. The symptoms usually don’t develop until you have healed from the infection.

While an internal medicine provider can treat some rheumatic diseases, they may refer you to a rheumatologist. Many of the conditions rheumatologists work with are complex, so going to a healthcare provider with specialized training may mean an earlier diagnosis and more efficient treatment.

Why Would You See a Rheumatologist?

If you have not yet been diagnosed with a rheumatic disease but are experiencing symptoms of one, you may want to consider seeing a rheumatologist. This is especially true if you have a family history of rheumatic disease since a family history of certain diseases could put you at higher risk for rheumatic conditions like RA.

Keep open conversations with your healthcare provider and tell them anytime you are experiencing new or worsening symptoms. When people are in pain, they often have difficulties thinking and remembering key details. It might be helpful to write down your symptoms, when they started, and if anything made them worse.

General symptoms to be mindful of are:

• Fevers
• Painful joints in the hands, wrists, and knees
• Joints that are swollen on both sides of the body
• Swollen and tender to the touch joints that also have warmth when touched
• Stiffness that lasts for more than 30 minutes in the morning or after inactivity

Depending on your insurance or the rheumatologist, you may need a referral from another healthcare provider before visiting a rheumatologist. 

If you aren’t the one to initiate a visit to a rheumatologist, then it might be your primary care provider who does. There are a few reasons why a primary care provider would refer you to a rheumatologist:

• They suspect you might have a type of inflammatory arthritis, like RA, lupus, or PsA, and want the diagnosis confirmed. 
• They’ve diagnosed you with an inflammatory arthritis, and now they want you to get a treatment plan. 
• You have new or unexplained symptoms or findings, such as fever, fatigue, rash, or abnormal laboratory results.

Your primary care provider will know when to send you to the specialized expert. The quicker you establish care with a rheumatologist when needed, the better. The first three months from when symptoms start is critical for treatment because it improves outcomes and reduces joint damage, decreasing the need for joint replacement surgery.

What Should You Expect When Visiting a Rheumatologist?

Understanding what to expect during your first visit with a rheumatologist can help make the appointment seem less intimidating.

Your rheumatologist will start by collecting history about any medical conditions you and your family have. They will also need to perform a physical exam where they will pay close attention to your joints and skin.

While every person will have different symptoms and levels of severity, there are some standard tests and treatments that a rheumatologist may order during your visit. 

Blood Tests

Lab tests a rheumatologist may order either on your first visit or follow-ups are:

• Complete blood count (CBC): A CBC measures many aspects of your blood and can help your provider diagnose anemia, which is common in RA.
• Rheumatoid factor (RF): RF is an antibody, which is a protein the body produces to fight infections. Rheumatoid factor levels in the blood can give insight into disease.
• Erythrocyte sedimentation rate (ESR): This test detects the amount of inflammation within your body. 
• Anti-cyclic citrullinated peptide antibody (anti-CCP): This test checks for anti-CCP antibodies in the blood that often appear before the symptoms of RA begin. Anti-CCP antibodies are present in some people with RA. It is helpful when used with the rheumatoid factor test in confirming a diagnosis. 
• C-reactive protein (CRP): This test helps detect inflammation in the body.

Once you undergo the testing, the rheumatologist may call to discuss your results or request that you return for a follow-up appointment to discuss the results and next steps in person.

Imaging Tests

Rheumatologists may order different types of imaging tests to help detect disease activity and monitor progression of rheumatic diseases. These tests include:  

• Magnetic resonance imaging (MRI): An MRI can be helpful in the early stages of RA. This test helps see where there is active joint inflammation and how much bone breakdown there has been. 
• Ultrasound: This test helps detect early signs of inflammation and joint complications. While it is less expensive and often more tolerable than an MRI, the success of the scan depends on the person operating the machine as well as the quality of the device itself. 
• X-ray: An X-ray can be used to monitor an already-diagnosed disease and to confirm there is nothing else causing the joint pain.

Your rheumatologist may request a follow-up appointment once they receive and review the images. 

Common Treatment Options

Treatment can vary widely based on what condition you have and how severe it is. But especially early on, there are two main treatments a rheumatologist will prescribe: medications and therapy.

The medications rheumatologists prescribe often focus on decreasing inflammation, managing pain, and slowing destruction of your joints. There are many types of medications, including anti-inflammatories and corticosteroids.

A rheumatologist may also recommend physical or occupational therapy. Physical therapy helps you regain strength and assists with regaining function in your joints. Occupational therapy is important in improving daily living skills, like grabbing objects and putting on clothing.

Your rheumatologist may suggest other treatment options depending on how advanced your disease is or how much joint damage you have. Your healthcare provider might also discuss surgery if the amount of joint damage and pain you are experiencing is severely affecting your life. 

How Should You Prepare for a Visit to a Rheumatologist?

Being prepared for your visit and having everything you need can help you get diagnosed and started on a treatment plan more quickly. Technology allows most health records to be electronically submitted and sent to your rheumatologist before the appointment. However, it is always best to come with everything you can so that your specialist can have everything needed in front of them.

Have a list of all your current medications, including their names, how often you take them, and the dosage. If you’ve already tried a medication for the problem, note that too.

Know your family's medical history, especially any information about anyone who might have a musculoskeletal or autoimmune issue.  

If you had any prior imaging or bloodwork, make sure those results were shared with the rheumatologist prior to your appointment.  

A Quick Review

A rheumatologist is an internal medicine physician or pediatrician who specializes in rheumatology. They receive extra training to diagnose and treat rheumatic diseases, which include musculoskeletal conditions and autoimmune diseases like rheumatoid arthritis, gout, and lupus. Your primary care provider might refer you to a rheumatologist when you are having symptoms that may indicate a rheumatic disease, including joint pain, fatigue, and stiffness. Early detection of a rheumatic condition can help prevent damage and worsening of symptoms. But know that, even if you arrive at your appointment prepared with all the information you need, it may take a few appointments to get a diagnosis and treatment plan since many rheumatic diseases are complex. Once you get started on a treatment plan, though, your quality of life usually improves.