Rheumatology

What is it?

According to the ACR: an "internist or paediatrician who has received additional training in the diagnosis and treatment of musculoskeletal diseases and systemic autoimmune conditions", who specialises in the joints, muscles, bones and immune system by non-surgical means. The ACR explains that in autoimmune diseases the immune system mistakenly directs inflammation against the body's tissues, causing inflammation in the joints, muscles, vessels, kidneys and elsewhere (examples are rheumatoid arthritis, systemic lupus, scleroderma and vasculitis). MedlinePlus describes it as pain and other symptoms in the joints and parts of the musculoskeletal system.

Conditions it covers

According to the ACR: osteoarthritis, gout, rheumatoid arthritis, chronic back pain, tendinitis and bursitis, and lupus. The ACR states that psoriatic arthritis is a chronic inflammatory autoimmune condition diagnosed and treated by the rheumatologist, and often (but not always) affects people who have psoriasis. It states that osteoporosis is a condition treated by primary care physicians, endocrinologists and rheumatologists.

Related pages on this site: osteoarthritis, osteoporosis, psoriasis (in terms of psoriatic arthritis), the joints and the immune system.

Common tests and procedures

According to the ACR: a comprehensive medical history and physical examination, and laboratory tests and imaging (X-ray, ultrasound, CT, MRI) may be requested. Recommendations include: medicines, referral for physical and occupational therapy, specialist consultations, and joint injections. For psoriatic arthritis the ACR mentions a clinical examination, imaging and blood tests, and options that begin with non-steroidal anti-inflammatory drugs for mild flares and extend to disease-modifying drugs (DMARDs) and biologic drugs for more severe cases, and the doctor chooses the plan with you.

When to see one

Referral to the specialist is usually decided by the primary care provider according to the condition (MedlinePlus). The ACR states that signs calling for referral are: recurrent fever, joint swelling, fatigue, rash, anaemia, weakness or unexplained weight loss; morning stiffness lasting more than 30 minutes or recurrent swelling of small joints; hair loss or oral or genital ulcers; sudden vision problems; and abnormal laboratory results suggesting lupus, rheumatoid arthritis or vasculitis. It stresses that early diagnosis and treatment help prevent permanent damage.

Common questions