What is rheumatology?
The field of rheumatology is a subspecialty within the vast field of internal medicine. It involves studying and treating conditions affecting the joints and surrounding muscles, tendons, and ligaments. Blood vessels and organs such as the eyes, gastrointestinal tract, kidneys, lungs, neurological system, and skin may also be affected.
It is possible to categorize rheumatology into two main categories:
- Diagnosing and treating inflammatory illnesses affecting the joints and surrounding tissues.
- Diagnosing and treating generalized diseases like osteoarthritis, mechanical and degenerative spinal problems, and soft-tissue conditions affecting muscles, tendons, and ligaments around joints result in joint abnormalities, discomfort, stiffness, and edema.
Understanding rheumatic diseases
Rheumatic diseases impact joints, tendons, ligaments, bones, and muscles, often referred to as musculoskeletal diseases. These include various forms of arthritis, with osteoarthritis being one of the most common types. Rheumatic diseases also encompass autoimmune conditions like rheumatoid arthritis and lupus.
Most rheumatic diseases are linked to immune system dysfunction, where the immune system mistakenly attacks the body’s tissues. While the exact cause is unclear, several factors may increase the risk of developing a rheumatic disease:
- Genetics: Certain genetic mutations may elevate the risk.
- Sex: Some rheumatic diseases are more prevalent in one sex. For instance, rheumatoid arthritis and lupus are more common in women, while ankylosing spondylitis is more frequent in men.
- Weight: Obesity can raise the risk for certain rheumatic conditions.
- Lifestyle habits: Smoking is a known risk factor for rheumatoid arthritis and other rheumatic diseases.
- Environmental exposure: Exposure to toxins, pollutants, and chemicals can increase the likelihood of developing a rheumatic disease.
These factors and individual health history can inform a rheumatologist near you on how to best plan your treatment.
Who is a rheumatologist?
A rheumatologist is an internist or a pediatrician with additional training in detecting and treating disorders affecting muscles, bones, joints, ligaments, and tendons. While an orthopedic surgeon's job is to operate on the musculoskeletal system, the function of a rheumatologist is to determine what kind of musculoskeletal disease a patient has and treat it non-surgically.
Who is a pediatric rheumatologist?
A pediatric rheumatologist specializes in diagnosing and treating children with complex autoimmune and inflammatory conditions. These conditions include juvenile idiopathic arthritis (formerly juvenile rheumatoid arthritis), systemic lupus, dermatomyositis, scleroderma, vasculitis, autoinflammatory diseases, and periodic fever syndromes.
To become a pediatric rheumatologist, a doctor must be board-certified in general pediatrics. Only then can they pursue certification through the American Board of Pediatrics Sub-board of Pediatric Rheumatology, reflecting their advanced expertise in treating complex rheumatic conditions in children.
Pediatric rheumatologists are known for their skill in unraveling complex medical puzzles. They are often called on as expert diagnosticians to tackle challenging cases. Because rheumatic diseases can affect multiple systems in the body, these specialists work closely with nearly all other medical subspecialties.
While pediatric rheumatologists primarily see patients in outpatient clinics, they may also consult or care for hospitalized patients. The chronic and intricate nature of rheumatic disorders allows these specialists to build lasting relationships with patients and their families, often coordinating care across various medical teams and support services to ensure comprehensive treatment.
Education of a rheumatologist
The educational qualifications of a rheumatologist include:
- Undergraduate and medical school: A typical undergraduate bachelor's degree is the first step in training to be a rheumatologist, followed by four years of medical school (Doctor of Medicine; MD) or osteopathic training (Doctor of Osteopathy; DO). Generally, osteopathic practitioners take a holistic approach to treatment in tandem with a person's mind, body, and spirit.
- Internships and residencies: After receiving a medical degree, doctors may complete internships in internal medicine or pediatrics, after which they pursue a three-year residency specializing in the same. Throughout their residency training, medical professionals receive expertise in treating various illnesses. To subspecialize, doctors must pass an internal medicine or pediatric board exam.
- Fellowships: To become a qualified rheumatologist, doctors must finish a two to three-year fellowship, also known as subspecialty training. Specific training in musculoskeletal and autoimmune or inflammatory illnesses is provided during this curriculum.
- Board certifications: A medical practitioner is not required to be board-certified to become a rheumatologist. However, holding these titles shows a doctor's determination and dedication to becoming the finest rheumatologist possible.
What conditions does a rheumatologist treat?
There are over a hundred types of rheumatic diseases and conditions. A rheumatologist near you can treat:
- Musculoskeletal pain disorders: They cause discomfort in muscles, bones, tendons, ligaments, or joints. Conditions like arthritis or strains cause pain, limit movement, and affect daily life.
- Osteoarthritis: It is a degenerative joint disease causing pain and stiffness, common in aging, and affects knees, hips, ankles, feet, basal joints, and lower back, impacting daily activities.
- Osteoporosis: Osteoporosis refers to a bone disease characterized by weakened, porous bones with increased fracture risk. It results from bone density loss, often associated with aging, hormonal changes, or insufficient calcium intake.
- Gout: Gout is a type of arthritis. It leads to severe pain, swelling, and inflammation. It commonly affects the big toe, followed by ankles, feet, knees and wrists, elbows, and fingers in severe cases.
- Back pain: Back pain is discomfort or soreness in the spinal area, ranging from mild to severe. Causes include muscle strain, herniated discs, or structural issues. It can affect daily activities and mobility.
- Fibromyalgia: It is a severe disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in specific areas. Symptoms often include sleep disturbances, lightheadedness, cognitive issues, etc.
- Tendonitis: It is the inflammation of a tendon, typically due to overuse or injury. It results in localized pain, swelling, and impaired movement in the affected area, commonly seen in joints.
- Rheumatoid arthritis: It refers to an autoimmune disorder causing chronic inflammation in joints. It leads to pain, swelling, and joint damage. The immune system mistakenly attacks healthy tissues, primarily affecting small joints.
- Lupus: Lupus develops when the immune system attacks healthy tissues mistakenly, leading to inflammation and damage in various organs. Common symptoms include joint pain, skin rashes, hair loss, swollen lymph nodes, kidney disease, and fatigue.
- Antiphospholipid syndrome: It is an autoimmune disorder causing abnormal blood clotting. It can result in miscarriages, thrombosis, and other complications due to the immune system mistakenly attacking phospholipids.
- Scleroderma, vasculitis, and myositis: Scleroderma is a connective tissue disorder causing skin thickening. Vasculitis is inflammation of blood vessels. Myositis involves muscle inflammation and weakness. All are autoimmune conditions with diverse symptoms affecting multiple organs and tissues.
Rheumatologists may use different techniques and modalities for assessing, diagnosing, and treating all these conditions and issues.
What procedures do rheumatologists perform?
Rheumatologists perform several tests and procedures to help diagnose and treat rheumatic ailments, such as:
Physical evaluations
A rheumatologist typically conducts a complete physical evaluation when seeing a person for the first time or observing the effects of a current treatment plan. During the physical evaluation, they assess the patient's overall physical health, from checking their pulse to examining the areas where the person has reported pain or stiffness. They also review the person's medical history, current medications, and family history and investigate other related symptoms to provide a thorough diagnosis.
Diagnostic testing
Rheumatologists usually diagnose systemic inflammatory and musculoskeletal disorders. They require various tests to identify and assess the underlying cause of a person's symptoms. Here are some of the most likely causes of inflammation:
- abnormal uric acid metabolism
- autoimmune disorders
- environmental exposure
- genetics
- infections
They can also diagnose illnesses that cause loss of bone or cartilage, including osteoarthritis and osteoporosis.
Imaging tests
A primary care doctor or a rheumatologist can use multiple imaging tests to find signs of joint damage. These tests include CT scans, MRIs, ultrasounds, and X-rays.
Laboratory testing
Commonly, laboratory testing involves collecting blood, joint fluid, skin, or urine samples for analysis. A rheumatologist uses these lab results to determine the signs of inflammation and infections, such as spiked levels of antibodies, inflammatory reactants, or white blood cells. They also conduct other tests to search for genetic markers, such as HLA-DR4, ARTS 1, and IL23R, that may increase a person's risk of specific autoimmune or inflammatory disorders.
Rheumatologist vs. orthopedist
Orthopedists and rheumatologists focus on disorders affecting the bones, joints, ligaments, muscles, and tendons. However, there are some differences between these two specialties.
Rheumatologists regard every organ system when looking for the cause of your symptoms, whereas an orthopedist focuses on congenital disorders, degenerative conditions, and injuries. Furthermore, orthopedists can perform surgeries while rheumatologists cannot.
Although orthopedists and rheumatologists diagnose and treat musculoskeletal disorders, rheumatologists have specialized training in musculoskeletal disorders of an autoimmune and inflammatory etiology.
Preparing for your first visit with a rheumatologist
Most of the time, rheumatologists practice in outpatient clinics. Primary care doctors or other medical professionals may refer you to a rheumatologist for a diagnosis. One can also book appointments with rheumatologists without a recommendation from another doctor.
Since you may experience many symptoms that may change abruptly or gradually over time, keeping a symptom journal before seeing a rheumatologist near you is highly recommended. You will likely remember everything better if you jot down your symptoms along with their frequency. You should also save copies of your medical history records. This covers any prescription medications, vitamins, and supplements you might be taking for other medical issues.
It is difficult and complex to detect rheumatic disorders, so a rheumatologist near you will conduct a thorough physical examination to look for symptoms that may provide information about the problem's origin. Rheumatic disease diagnosis may also benefit from the knowledge of your family history.
The rheumatologist will review the findings of any earlier tests and may request additional laboratory tests, imaging investigations (X-ray, ultrasound, CT scan, MRI), or other procedures to look for further potential hints to the likely origin of your musculoskeletal condition.
Rheumatologists may treat recurring diseases or speak with patients about drugs, coping processes, methods of avoiding disability or regaining function, and ways to enhance their quality of life during follow-up consultations.
Find the best rheumatologist near you in Los Angeles, CA
Appropriate selection of a rheumatologist is crucial. Most individuals have the preconceived impression that seeing any healthcare professional might be uneasy and intimidating. However, visits and procedures can be much smoother with the right doctor.
You may maximize the value of your trips and appointments with the aid of Zocdoc. Visit the Zocdoc website and enter your condition or symptoms, location, and insurance details. Click on "find" and browse through a list of qualified rheumatologists. You can further filter your search based on gender, languages spoken, hospital affiliations of the doctor, and the insurance they accept.
Choose your insurance plan from the search filters or update your Zocdoc account’s insurance information to find providers within your insurance network. Smartphone users can even upload a picture of their insurance card to the Zocdoc app to find rheumatologists near them who accept their insurance. Check out Zocdoc’s patient help center for answers to insurance-related FAQs.
Zocdoc's provider profiles include a rheumatologist's credentials, clinical interests, patient feedback, ratings, and everything else you need to know before booking an appointment. Therefore, you can make an informed decision before making an appointment.
What's more? You can book both online or offline appointments through Zocdoc. Just look for a purple button on the profiles of rheumatologists who allow video appointments.
Finding excellent and economical medical care is now easier! Booking appointments with physicians on Zocdoc has always been simple, secure, and free!
The burden of arthritis: Los Angeles and the United States
Swelling and tenderness in the joints are called arthritis. Many types of (100+) arthritis primarily affect joints, the tissues around the joints, and other connective tissues. As per the California Department of Public Health, the most common symptoms of arthritis are stiffness and pain in and around joints. They affect more than 52 million Americans and more than 5.9 million Californians (20%). Fifteen million people aged 18 and older reported excruciating joint pain in 2015.
Although Los Angeles County's (≈20%) arthritis prevalence is comparable to the nation's (≈21%), the percentage of people with arthritis who reported arthritis hindering their daily life was noticeably more significant in LA County (≈50%) than in the nation as a whole (≈38%).
Between 2013 and 2015, about 58.5 million US adults (≈22.7%) were annually diagnosed with conditions like fibromyalgia, gout, lupus, and other types of arthritis. With 43 million American adults affected, arthritis is the nation's most common cause of disability. The estimated yearly capital loss due to arthritis is $35 billion in indirect expenditures, such as lost productivity, and $51 billion in medical expenses.
The prevalence of arthritis is expected to reach 67 million in the United States by 2030 (or ≈25% of the adult population), adding to the burden of the disease.
Sources
Medical News Today
Science Direct
American College of Rheumatology
Cleveland Clinic
County of Los Angeles Department of Health Services Public Health
California Department of Public Health
Centers for Disease Control and Prevention[1]
Centers for Disease Control and Prevention[2]
Hospital for Special Surgery[1]
Hospital for Special Surgery[2]
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Hospital for Special Surgery[7]
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Hospital for Special Surgery[11]
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Council of Pediatric Subspecialties
WebMD
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