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Who are rheumatologists, and what do they do?

Rheumatology is a field of medicine that focuses on musculoskeletal diseases, autoimmune disorders, and inflammatory conditions in all age groups. Rheumatologists are internal medicine doctors or pediatricians with special training in rheumatology. They are experts in detecting and managing disorders affecting the muscles, bones, joints, ligaments, and tendons.

Rheumatism denotes a cluster of disorders characterized by joint discomfort, stiffness, and swelling, which typically advance and may result in joint deformities. Rheumatic conditions are commonly present as dry eyes, dry mouth, dermatitis, alopecia (loss of hair), fatigue, itching, joint swelling and stiffness, muscle weakness, and lymph node swellings.

Autoimmune disorders cause the body's immune system to attack healthy cells, leading to inflammation, pain, and swelling in affected parts and, ultimately, organ damage. They occur due to the immune system's inability to differentiate between the body's healthy and foreign cells. Autoimmune disorders generally affect the eyes, nerves, lungs, skin, heart, and kidneys. Some common autoimmune conditions include systemic lupus erythematosus, scleroderma, rheumatoid arthritis, Sjogren's disease, vasculitis, and polymyositis. 

Training and qualifications of rheumatologists in the US

To become a licensed rheumatologist in the US, one must complete the following:

• After completing a four-year medical school program, doctors earn either a Doctor of Medicine (MD) or a Doctor of Osteopathy (DO) degree. It is followed by three years of residency training in internal medicine, pediatrics, or both.
• Clear the internal medicine or pediatrics board examination to subspecialize in rheumatology.
• Finish two to three years of fellowship in rheumatology.
• Lastly, they must get certified by the American Board of Internal Medicine to practice in the US.

What conditions do rheumatologists diagnose and treat?

Rheumatologists detect and treat a variety of musculoskeletal conditions in our bodies. Common diseases include rheumatoid arthritis, fibromyalgia, osteoporosis, gout, tendonitis, osteoarthritis, psoriatic arthritis, lupus, scleroderma, and myositis:

• Rheumatoid arthritis is an autoimmune ailment characterized by persistent joint inflammation, bone erosion, and joint deformities. Beyond joint-related issues, this condition also impacts additional organ systems, encompassing the heart, lungs, skin, eyes, and blood vessels. Among individuals with rheumatoid arthritis, the immune system turns against healthy cells, provoking distressing swelling and discomfort. Rheumatologists generally use blood tests to detect antibodies and diagnose rheumatoid arthritis. Several imaging studies, such as X-rays, ultrasounds, and MRI scans, are used to check for the severity of the condition. 

• Fibromyalgia is a chronic condition where patients experience extreme pain and tenderness, causing difficulty in walking and other movements. Other common symptoms of fibromyalgia are sleep, memory, and mood issues. Even though fibromyalgia does not damage the bones and joints, people with rheumatic conditions that affect the joints, such as rheumatoid arthritis or spondylosis, are more susceptible to developing fibromyalgia. Even though there are no blood or imaging tests to diagnose fibromyalgia, rheumatologists use medical history and physical examination to detect this condition.

• Osteoporosis is a condition that alters the regeneration of bones. In affected patients, the formation of bones is slower than their resorption, thus leading to loss of bone mass and change in the bone structure. Menopausal women (around 50 years of age) or people of Asian or white ethnicity with small bone structures or a history of fractures have a higher risk of osteoporosis. The bone mineral density test is the standard rheumatologists use to diagnose this condition. Osteoarthritis, described as the "wear and tear" of joints in layman's terms, is a chronic condition generally affecting middle and old-aged adults. The disease causes the cartilage, ligaments, and tendons holding the bones and joints together to deteriorate and break down. It leads to joint pain and stiffness, reduced function, cracking sounds during movement, and swelling in the shared space. Osteoarthritis progresses slowly and commonly affects joints such as hands, hips, and knees. Rheumatologists diagnose this condition by examining the medical history and physically feeling the patient's joints. Imaging tests help ascertain the extent of the disease's progression.

• Systemic lupus erythematosus (SLE) is an autoimmune ailment where all branches of the immune system attack the body's healthy cells, leading to severe inflammation in bones, joints, and organ systems such as the heart, lungs, kidneys, and brain. SLE commonly presents symptoms like red-colored oval, round, or butterfly-shaped rashes, painful sores in the nose and mouth, pain and tenderness, and joint swelling. Besides these, patients having SLE also show pericarditis (swelling of the heart lining), pleuritis (inflammation of the lining of the lungs), poor kidney functions (protein and blood in the urine), and neurological issues such as stroke, seizures, and psychosis. Individuals with SLE also commonly exhibit pleuritis (inflammation of the lung lining), pericarditis (inflammation of the heart lining), impaired kidney function (indicated by protein and blood in the urine), as well as neurological complications such as strokes, seizures, and psychosis. 

• Gout is arthritis in which uric acid accumulates within the joints, resulting in painful inflammation and the potential for deformities. The symptoms generally start in a single joint, such as the big toe. 

• Scleroderma is a rare autoimmune condition that leads to skin thickening and inflammation of organs such as the heart, lungs, intestinal system, and kidneys. While localized scleroderma only affects the skin, the systemic form of this disease spreads to other organs.

Who can get rheumatoid arthritis?

Approximately 1.3 million individuals in the United States are impacted by rheumatoid arthritis (RA), with females being 2.5 times more susceptible than males. While RA can develop at any age, it is most commonly diagnosed between individuals aged 30 and 60. Young-onset rheumatoid arthritis (YORA) typically affects individuals between 16 and 40, while later-onset rheumatoid arthritis (LORA) is prevalent among adults aged 60 and above.

Rheumatoid arthritis treatment

Although rheumatoid arthritis (RA) has no known cure, research and advances in the last few years have immensely improved the outcomes that most patients can expect. The treatment of RA is now focused on minimizing joint damage, achieving the lowest possible level of disease activity and remission (if possible), and improving physical function, mobility, and quality of life. The treatment requires an all-inclusive program involving medical, social, and emotional support for the patient. The patient and their family must be educated about the nature and course of the disease.

RA treatment via pharmacological strategies entails three general classes of drugs:

• Non-steroidal anti-inflammatory agents (NSAIDs): Different NSAIDs available include ibuprofen (Advil , Motrin, Nuprin ), naproxen (Alleve), meloxicam (Mobic)), nabumetone (Relafen), etodolac (Lodine, sulindac (Clinoril), diclofenac (Cataflam, Voltaren, Arthrotec), choline magnesium salicylate (Trilasate), diflusinal (Dolobid), tolementin (Tolectin), indomethacin (Indocin®), ketoprofen (Orudis, Oruvail®, oxaprozin (Daypro), meloxicam (Mobic®), and piroxicam (Feldene).
• Corticosteroids: Corticosteroids like prednisone, methylprednisolone, and medrol® have anti-inflammatory and immunoregulatory activity. Intra-articular corticosteroids, such as triamcinolone or methylprednisolone, etc., are effective in controlling a joint local flare without changing the overall drug regimen.
• Disease-modifying anti-rheumatic drugs (DMARDs): DMARD agents have proved to alter the disease course and enhance radiographic outcomes. Currently, available drugs are methotrexate (Rheumatrex, Trexall), hydroxychloroquine (Plaquenil ), sulfasalazine (Azulfidine), tumor Necrosis Factor Inhibitors— etanercept (Enbrel, adalimumab (Humira ), leflunomide (Arava), and infliximab (Remicade), golimumab (Simponi), certolizumab pegol (Cimzia®), T-cell costimulatory blocking agents—abatacept (Orencia), B cell depleting agents— Interleukin-6 (IL-6) Inhibitors– tocilizumab (Actemra), rituximab (Rituxan®), Interleukin-1 (IL-1) receptor antagonist therapy—anakinra (Kineret®), Intramuscular Gold, and other immunomodulatory and cytotoxic agents like azathioprine (Imuran®) and cyclosporine A(Neoral, Sandimmune).

Other treatment modalities for the disease include reducing joint stress, occupational and physical therapies, and surgical intervention. Your rheumatologist may decide on the best course of action based on your condition. 

What kind of lifestyle changes help with RA?

While you cannot control certain aspects of RA, lifestyle changes like the following may help:

• Take enough rest: Inflamed joints increase the risk of injury to them and nearby soft tissue structures. Hence, giving them proper rest is essential. However, working out is still important. Maintaining a decent range of motion in your joints and general fitness is vital when dealing with RA.
• Regular exercise: Pain and stiffness might make it difficult to move. People with RA usually become inactive, resulting in a loss of joint mobility and muscle strength. This, in turn, causes more pain and fatigue. Regular exercise can control and reverse these effects. Consulting a physical or occupational therapist for advice can help.
• Moderate alcohol consumption: Regular alcohol consumption, alongside certain medications for rheumatoid arthritis, might heighten the risk of liver damage. Discussing your alcohol consumption with your doctor is crucial, especially if you are taking medication, even if it is just wine or beer.
• Quit smoking: Smoking can heighten the risk of rheumatoid arthritis. Quitting it can potentially alleviate your symptoms.

What should you expect from a visit with a rheumatologist near you?

Rheumatology appointments involve dealing with the complexities of rheumatic diseases and the difficulties in diagnosing them. Rheumatologists conduct thorough assessments during your visit. As you get ready for your appointment with a rheumatologist, here is what you can expect:

• Thorough evaluation for complex rheumatic diseases: When you visit a rheumatology clinic, get ready for a detailed check. Rheumatologists are experts at handling tricky cases that can be hard to diagnose. They go through your medical history and do a careful physical exam. It helps them figure out what is causing muscle and joint issues.  
• Family history: Your family's health history is a big help in diagnosing rheumatic diseases. The rheumatologist will ask about it to see if there are any patterns. The more information you provide, the better they can understand your situation.  
• Tests and images: Your previous test results are essential, but the specialist may recommend more tests—extra blood tests, X-rays, ultrasounds, CT scans, or MRIs. These tools help uncover hidden issues that might explain your problems.  
• Dealing with complexity through follow-ups: Some rheumatic problems need time, so you might have to return a few times. Your treatment options could include the following:
• Medicines
• Visits to other specialists
• Physical or occupational therapy
• Shots for your joints or tendons

Your rheumatologist will help adjust your treatment in follow-up appointments. They will address ongoing issues, change your medicines if needed, suggest ways to handle problems and give you tips on improving your overall quality of life.

How can you find the best rheumatologist near you in Brooklyn, New York? 

The best portal for finding a rheumatologist who meets all your requirements is Zocdoc - a platform that gives you access to the top medical practitioners near you. To get started, visit the Zocdoc website and enter the condition or symptoms you need treatment for, your preferred location, and medical insurance. It will generate a list of rheumatologists who match your criteria.

All rheumatologists on Zocdoc have a dedicated profile page listing all the details you need to make an informed decision about the doctor. The profile contains the rheumatologists' educational background, years of training, certifications, licenses, areas of specialization, work experience, and awards received in the past. It also informs you about the doctor's gender, the languages they speak, their place of work, the available days and times for consultation, and any conditions for which they have special training.

You can make in-person or online appointments using Zocdoc after checking if the rheumatologist of your choice is in-network. If you choose your current medical insurance policy and plan from the drop-down menu on Zocdoc, the application will let you know which doctors accept your insurance. Since many rheumatic conditions are chronic and require long-term treatment, it's better to have insurance cover part of the fees.

If you are still looking for your insurance plan within Zocdoc's listings, you can upload a photo of your medical insurance card to facilitate identification. However, it is essential to note that this feature exclusively applies to medical insurance cards and cannot be utilized for vision and dental insurance cards. Once uploaded, Zocdoc's system scans the image to ascertain and display your probable insurance plan. Additionally, for any further inquiries related to insurance matters, please reach out to Zocdoc's patient help center.

Finding the desired rheumatologist near you is now easier! 

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Prevalence of rheumatic conditions in Brooklyn, New York

According to the Centers for Disease Control and Prevention (CDC), in 2021, nearly 20.9% of adults in New York were diagnosed with arthritis. Approximately 41% of diagnosed adults faced workplace limitations because of the condition's adverse effects. Moreover, almost 8.5% of these patients complained of constraints in their daily activities, and around 32.8% suffered from severe joint pain because of arthritic complications. Additionally, the prevalence of arthritis was lower in men (≈24.7%) than in women (≈31.1%).

Brooklyn, New York, is coextensive with King's County. According to the CDC website, the prevalence of arthritis among adults in King's County in 2015 was around 20.2%. However, according to the New York State Department of Health, only about 19.3% of adults in King's County were diagnosed with arthritis in 2016. Thus, this brings down the number marginally from the previous year. Moreover, King's County was among the counties with the lowest percentage of adults diagnosed with arthritis.

Sources

Cleveland Clinic[1]

WebMD

American College of Rheumatology[1]

American College of Rheumatology[2]

American College of Rheumatology[3]

American College of Rheumatology[4]

American College of Rheumatology[5]

American College of Rheumatology[6]

American College of Rheumatology[7]

American College of Rheumatology[8]

Mayo Clinic

Centers for Disease Control and Prevention

New York State Department of Health

Cleveland Clinic[2]

NYU Langone Health

Johns Hopkins Medicine

The content herein is provided for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Medical information changes constantly, and therefore the content on this website should not be assumed to be current, complete or exhaustive. Always seek the advice of your doctor before starting or changing treatment. If you think you may have a medical emergency, please call your doctor or 9-1-1 immediately.