A Rheumatologist is a Board-Certified Doctor who specializes in the diagnosis and treatment of all rheumatologic conditions, such as those related to the inflammation of the joints (arthritis), muscles (myositis), and other internal organs. Because the cause of many systemic inflammatory diseases is autoimmune, these physicians are experts in understanding and treating the process of autoimmunity.
Autoimmune conditions result from loss of regulation of the immune system that leads to a mistaken attack on our own body, with resulting unwanted inflammation in a wide variety of tissues and organs, including the joints, skin, eyes, nervous system, muscles, kidneys, and other internal organs. Lupus is an example of an autoimmune disease that rheumatologists commonly treat. Due to frequent joint involvement, rheumatologists are experts in a variety of joint diseases as well, including rheumatoid arthritis, osteoarthritis, lower back arthritis, gout, and tendinitis.
Medical doctors who specialize in Rheumatology undergo a strict educational and training curriculum in order to acquire the level of expertise required to provide you with the highest level of medical care. These specialists complete a full residency in Internal Medicine or Pediatrics prior to completing an advanced specialized fellowship training program in Rheumatology.
Due to the chronic nature of many autoimmune diseases, patients and doctors often develop a long-term relationship. It is important that you choose a physician that you feel comfortable with, and are able to easily communicate with. Your primary healthcare provider (Internal Medicine, Family Medicine, Pediatrics, or OB/GYN) can facilitate a referral, and you can also do your due diligence by checking the credentials and practice style of the doctor. At myDoqter, you have access to patient feedback about doctors, and you can also see the professional recommendations given by other physicians who have witnessed first-hand the expertise and professional competency of your doctor.
Rheumatologists are doctors (M.D. or D.O.) with advanced medical degrees and training. The following is a representation of the years of education and training that a rheumatologist has undergone.
RHEUMAT from the Greek word ‘rheuma’ for ‘flow’ or ‘discharge’ + LOGY from the Greek word ‘logia’ which means ‘logic’ or ‘the study of’.
Rheumatologists treat an extensive list of conditions, including:
Rheumatoid Arthritis: An autoimmune inflammatory disease than creates inflammation in the lining of the joints, but can affect other organs including the skin, eyes, and blood vessels. As in all autoimmune diseases, it occurs when your immune system mistakenly attacks your own body’s organs and tissues.Rheumatoid arthritis affects women more than men and usually begins to manifest in middle age. Having a family history (genetics) of rheumatoid arthritis, obesity and cigarette smoking are considered risk factors for developing this condition. In rheumatoid arthritis, the small joints tend to be involved first, such as those of the hands and feet. Gradually, over time, other joints become affected as well. Over 40% of patients with rheumatoid arthritis will have other organ involvement, including the skin, eyes, lungs, heart, kidneys, nervous system and blood vessels. Many medications can successfully control the progression of rheumatoid arthritis, but in some very aggressive cases it still can lead to significant disfigurement and disability.
Psoriatic Arthritis: An inflammatory joint disease that often occurs in the setting of psoriasis. Psoriasis not only affects the skin with red scaly patches, but it also causes inflammation, swelling and pain in joints such as those of the fingers and toes. Psoriasis can also cause a process called spondylitis which affects the bones of the spine at the level of the neck and back. There are medications and a class of medical drugs called biologics that can significantly improve psoriatic arthritis.
Systemic Lupus Erythematosus: An autoimmune disease that creates inflammation throughout the body and can affect the skin, hair, eyes, blood vessels, kidneys, and other internal organs. There are certain laboratory abnormalities like blood autoantibodies and anemia found in connection to lupus erythematosus. The so-called titers of Anti-Nuclear Antibodies (ANA) can not only be indicators of the presence of the disease, but its levels in blood can be used to assess the severity of the disease, as well as to monitor the body’s response to a specific therapy being used to treat systemic lupus erythematosus in a patient.
Dermatomyositis: An inflammatory disease that affects the muscle and skin. It often develops in older adults, and it presents with a variety of skin rashes and muscle weakness. The skin rashes typically affect the face and the dorsal aspect or top of the hands. Specific blood tests are also used to assess the level of activity of dermatomyositis, as well as the response of the body to treatment.
Sjogren’s Syndrome: An autoimmune disease characterized by the presence of specific autoantibodies in the blood that attack the body’s own salivary and lacrimal (tear-producing) glands. This causes mucous membranes to lack the usual amount of moisture. It presents with symptoms of dry eyes and a dry mouth due to reduced saliva and tear production. Many times, Sjogren’s Syndrome often accompanies other autoimmune diseases such as lupus and rheumatoid arthritis. It is most commonly seen in women, and presents during middle age or later in life. Other symptoms include persistent cough, vaginal dryness and weakness. Treatment is mostly directed at managing and providing relief for the dryness of the eyes, mouth and all mucosal areas in general.
Vasculitis: An autoimmune reaction that creates inflammation of the blood vessels and can affect arteries, veins, and capillaries. Because these vessels feed a variety of organs, vasculitis can affect a variety of tissues. Vasculitis may present as an acute episode that clears fairly quickly without major side effects, or it may be associated with long-term disease in various organs. Vasculitis can affect organs such as the skin, intestines, brain and kidneys, among others.
Scleroderma: An autoimmune disease that causes tissue tightening and hardening of the skin and joints. It most commonly appears in women, between the ages of 30 and 50. Many patients with scleroderma also have a family history of one or more autoimmune diseases, such as lupus, rheumatoid arthritis and/or Hashimoto’s thyroiditis. Exposure to toxins such as benzene, polyvinyl chloride (PVC) and silica may trigger scleroderma in patients with a genetic predisposition to the disease. Organs that can be involved in the systemic form of scleroderma include blood vessels, the gastrointestinal tract and kidneys. In severe cases, the lungs and heart can also be involved, leading to serious complications.
Sarcoidosis: A disease characterized by the accumulation of immune cells in various organs including the skin, lymph nodes, eyes, lungs and heart. These collections of immune cells are called granulomas. Granulomas may be innocuous and be associated with minimal to no side effects, but some can cause organ dysfunction if widespread. Sarcoidosis that affects the nervous system (including the brain), the lungs, kidneys and heart can lead to serious side effects. Sarcoidosis is most commonly seen in patients ages 20 to 60, and is slightly more common in women than men. Patients of African descent as well as those of Northern European descent have a higher incidence of sarcoidosis. Having a family history of sarcoidosis is also a predisposing factor to developing sarcoidosis. Treatment is aimed at managing the inflammation and the granulomas found in the various organs that are affected.
Lyme Disease: An infection caused by a microorganism species called Rickettsia. The rickettsia microorganisms are mostly the Borrelia burgdorferi and the Borrelia mayonii, which are transmitted by the bite of infected deer ticks. These ticks are commonly found in wooded areas, particularly in the Northeast of the U.S. Early identification of this condition and prompt treatment is important to prevent long-term complications of Lyme Disease. The first sign of Lyme Disease may be a bull’s- eye pattern of skin rash that develops at the site of the tick bite anywhere between 3 to 30 days later. Other symptoms include chronic inflammatory disease of the joints, heart, and nervous system. Treatment consist of specific oral or intravenous antibiotics, depending on the severity of the disease.
Lower Back Arthritis: A condition that may be caused by degenerative changes, but also may be caused by rheumatoid arthritis and other autoimmune diseases.
Gout: A type of arthritis that can produce severe attacks of pain, swelling, and redness of the joints. It often occurs in the first toe, although it can affect a variety of joints. It is due to accumulations of uric acid crystals in the joint and may be triggered by foods that are rich in purine, which is present in animal protein. Such foods include liver, beef, sardines, mackerel and herring. Alcohol intake or medications called diuretics can also precipitate an attack of gout, although through a different mechanism: As they cause urination and loss of fluid, the levels of uric acid in the blood also become more concentrated and they precipitate as crystals, leading to an attack of gout. Patients who suffer from gout are advised to follow a healthy diet that contains plant-derived proteins, vegetables, whole grains and low-fat milk and other dairy products.
Raynaud’s Disease: A vascular disorder of the fingers and toes in which the vessels constrict and spasm often when exposed to low temperatures or to stress. The affected fingers and toes can rapidly become numb, cold and alarmingly white or blue. This can be a significant problem for patients living in colder climates. Women are more likely to develop Raynaud’s Disease, and a family history is also a predisposition to developing this condition.
Osteoarthritis: Changes in the bones and joints that are due to degenerative events that happen with age.These are normally referred to as ‘wear-and-tear’ changes, and are commonly seen in older age patients.
Osteoporosis: A condition in which the quality and density of the bones are reduced and the structure of the bones becomes fragile and porous. These changes happen over time and are worse in the elderly. Osteoporosis is the most common metabolic bone disease. Although osteoporosis affects both men and women, postmenopausal women have the highest incidence rates.
Fibromyalgia: A systemic disorder of unknown cause that can cause a variety of life-disrupting symptoms, including fatigue, musculoskeletal pain, and mood changes. Some possible causes for fibromyalgia include genetics (having a family history of this disease), certain infections, physical trauma (a serious car accident, for example) or psychological stress (a death in the family, a divorce or other significant emotional stress). It affects women more commonly than men. Patients with a history of osteoarthritis, lupus erythematosus or rheumatoid arthritis may also have a greater predisposition to developing fibromyalgia. Several medications and various types of therapies can be used to treat the symptoms of fibromyalgia.
Ultimately, long-term Health Maintenance and Prevention of disease progression are key steps to maintaining long lasting health in the setting of chronic illnesses. Important recommendations include following a balanced nutrition and a healthy lifestyle with adequate sleep patterns and stress reduction, in combination with a daily exercise regimen. Make sure to discuss all specific treatment options and other preventive medicine recommendations with your doctor. Your rheumatologist can be your long-term partner in health, helping you and guiding you with the best treatment and lifestyle recommendations as you successfully manage a chronic inflammatory condition.
For more information on Rheumatology, you can visit the following sites:
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Health-Care-Team/What-is-a-Rheumatologist