Frequently Asked Questions
What is a Rheumatologist?
What kind of training do rheumatologists have?
After four years of medical school and three years of training in either internal medicine or pediatrics, rheumatologists devote an additional two to three years in specialized rheumatology training. Rheumatologist hold general medical licensure through the US Medical Licensure Board, and board certification in either Internal Medicine or Pediatrics as well as board certification in Rheumatology through the American Board of Internal Medicine.
What do rheumatologists treat?
Rheumatologists focus on conservative, non-surgical treatment of osteoarthritis and regional musculoskeletal conditions such as bursitis and tendonitis. Treatment includes the use of medications, joint injections, and physical therapy.
Rheumatologists also treat auto-immune forms of arthritis including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. These conditions can be crippling and typically require the use of immune system modifying medications.
Rheumatologists specialize in bone health including the early diagnosis and prevention of Osteoporosis.
Rheumatologists also treat auto-immune conditions known as connective tissue diseases, including Systemic Lupus Erythematosus, Sjogren’s Syndrome, and vasculitis.
Other conditions rheumatologists treat include gout, fibromyalgia, and back pain. Rheumatologists treat over 100 different conditions.
When should you see a rheumatologist?
- If musculoskeletal pains in the joints, muscles or bones is severe or persists for more than a few days.
- If you have any of the conditions discussed on this website.
- If your primary care physician recommends rheumatologic consultation. This often occurs when lab work drawn at your primary care physician’s office returns abnormal, including an Anti-Nuclear Antibody (ANA), Rheumatoid Factor (RF), or an Erythrocyte Sedimentation Rate (ESR).
- If you have questions or concerns about having or preventing osteoporosis.
Many types of rheumatic diseases are not easily identified in the early stages. Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. It’s important to determine a correct diagnosis early so that appropriate treatment can begin early. Some musculoskeletal disorders respond best to treatment in the early stages of the disease.
Because some rheumatic diseases are complex, one visit to a rheumatologist may not be enough to determine a diagnosis and course of treatment. These diseases often change or evolve over time. Rheumatologists work closely with patients to identify the problem and design an individualized treatment program.
What is Arthritis?
The word arthritis is a general term, not a specific illness. Most everyone knows that if someone has arthritis, then that person is having a problem with their joints. But, most people do not realize that there are over 115 different arthritic diseases. A few of the most common types are osteoarthritis, rheumatoid arthritis, and gout.
What are some of the most common types of arthritis?
Osteoarthritis (OA) is the most common kind of arthritis. The problem in OA is the breakdown of cartilage in joints. This causes pain in the affected joint with use. For example, OA in the knee causes knee pain with walking or climbing steps.
In rheumatoid arthritis (RA), inflammation causes the joints to be swollen, stiff, and tender. Unlike OA, however, the inflamed joints in RA will often feel better with use. Because it is an inflammatory illness, RA can affect other parts of the body, including the skin, nerves, heart, and lungs.
Gout is caused by uric acid, a chemical made by the body, which gets into the joints. It causes sudden episodes of very painful, swollen joints.
How can we help treat arthritis?
It is important to have an evaluation to determine which arthritic disease is causing the problem. Like other illnesses, early diagnosis and treatment of arthritis can impact the outcome of the illness.
The diagnosis of a particular kind of arthritis usually depends on a lot of different information. If someone with joint problems sees a rheumatologist, a medical doctor specializing in the diagnosis and treatment of arthritis, the evaluation will begin with a history of the problem: When did the symptoms start? Which joints hurt? Are the joints stiff? What makes the symptoms worse or makes them feel better? A physical exam of the joints, x-rays, and certain lab tests will also typically be done. It is important to know that the symptoms of some types of arthritis develops over time and may appear similar to other types in the early stages. It may take several visits before the doctor can tell what type of arthritis a patient has.
If joint symptoms occur and persist, it is important to determine which specific arthritic disease is causing the problem. Like other diseases, the earlier the diagnosis is made, the better the outcome is likely to be. Another reason to have an accurate diagnosis is that different arthritic diseases require different treatments. Most arthritic diseases are not curable, but most are manageable and respond to treatment, often requiring some combination of medication (pills or infusion), joint injection, physical therapy, and surgery.
What is Autoimmune Disease?
What is autoimmune disease? Rheumatologists specialize in the diagnosis and treatment of certain autoimmune diseases. The purpose of the immune system is to fight off harmful substances in the body, such as infections. In order to do this, the immune system must be able to tell the difference between normal healthy parts of the body (self) and harmful intruders (non-self.), just as police officers try to distinguish “good guys” from “bad guys.”
The immune system has many complex mechanisms for achieving this. Every once in a while, something goes wrong. If the immune system incorrectly labels a normal healthy part of the body as being harmful, it might attack the healthy part just as if it were a harmful bacteria. This is called autoimmunity. Autoimmune diseases are also commonly referred to as connective tissue diseases, because the connective tissue in the body is often the target.
The part of the body which is being attacked determines the type of autoimmune disease a person might have. For example, in rheumatoid arthritis the joints are attacked. In Lupus, the kidneys and skin can be attacked. In dermatomyositis, the skin and muscles can be attacked.
When is autoimmune disease suspected?
An auto-immune disease can affect virtually any part of the body, including the joints, muscles, kidneys, lungs, heart, and brain. An auto-immune disease can therefore manifest in countless ways. This can range from joint pain, muscle pain, and fatigue to fevers, rashes, and problems with organs such as kidneys and lungs.
If a patient has a particular symptom or problem that can not be explained by common conditions, a doctor might suspect an auto-immune disease as the cause, and refer the patient to a rheumatologist for further testing.
How are autoimmune diseases diagnosed?
The diagnosis of autoimmune diseases is not straightforward, and requires a history, physical exam, laboratory testing, radiography, and sometimes biopsies.
Blood tests can be helpful, but often do not hold the complete answer. The most common blood test first ordered when an autoimmune disease is suspected is the antinuclear antibody test, otherwise known as the ANA. There are dozens of other tests, most of which involve the immune system, that try to detect autoimmunity.
Blood tests are only part of the workup, and by themselves do not give a diagnosis. Many people have a positive ANA, but have no autoimmune disease (referred to as testing falsely positive.) Other patients might have conditions such as rheumatoid arthritis, with normal blood work (referred to as testing falsely negative.)
Because of the high incidence of false positive and false negative blood test results, the diagnosis of autoimmune disease can be a process of careful history taking, examination, and observation over time.
How are autoimmune diseases treated?
Because autoimmune diseases involve abnormalities of the immune system, they are often treated with medications that alter the immune system. Such medications are called immuno-modulatory medications. There are many, and they are tailored to the specific manifestations of a particular disease.