Rheumatologists are medical professionals who diagnose and treat systemic autoimmune diseases, such as rheumatoid arthritis, that may cause inflammation in the joints, tendons, ligaments, bones, and muscles.
People may need to visit a rheumatologist if they experience persistent joint pain or stiffness.
This article discusses the role of a rheumatologist, the types of conditions they treat, and the procedures they perform. It also explains why people may need to see a rheumatologist.
A rheumatologist is an internal medicine doctor who specializes in diagnosing and treating inflammatory conditions that affect the joints, tendons, ligaments, bones, and muscles.
Rheumatologists diagnose and treat musculoskeletal conditions, but they do not perform surgery.
Education and training requirements
According to the American College of Rheumatology (ACR), before a rheumatologist can start treating patients, they must fulfill the following education and training requirements:
- graduate from a medical school
- complete a residency program
- participate in a rheumatology fellowship
After completing a rheumatology fellowship program, they must pass a board examination and receive a certificate to practice rheumatology. They will need to retake this exam every 10 years to maintain their certification.
Rheumatologists must also participate in continuing education courses throughout their career.
A rheumatologist can choose to treat specific rheumatic conditions or narrow their focus to a particular area, or subspecialty, within rheumatology.
Subspecialties in the field of rheumatology
- autoimmune and inflammatory conditions
- noninflammatory degenerative joint conditions
- soft tissue diseases
- chronic pain
- metabolic disorders that affect the bone
- pediatric or juvenile rheumatic conditions
A rheumatologist might also choose to work as a clinical educator, conduct research, partner with government agencies to develop public health policies, or work within the pharmaceutical industry.
Rheumatologists can treat autoimmune and inflammatory conditions that affect the joints, tendons, ligaments, bones, muscles, and blood vessels.
- inflammatory arthritis of the knees, hips, or shoulders
- rheumatoid arthritis
- psoriatic arthritis
- systemic lupus erythematosus
- giant cell arteritis
- Behcet’s disease
- polymyalgia rheumatica
- inflammatory myopathies, including polymyositis, dermatomyositis, and inclusion body myositis
- Paget’s disease
- ankylosing spondylitis
- Reiter’s syndrome
- reactive arthropathies, secondary to bowel disorders, skin disease, or infections
- Sjögren’s disease
- idiopathic juvenile arthritis
- vasculitis, including specific types such as granulomatosis with polyangiitis
Rheumatologists also routinely diagnose and treat complications of autoimmune conditions, such as interstitial lung disease.
The Centers for Disease Control and Prevention (CDC) report that each year between 2013 and 2015, about
Rheumatologists perform examinations and procedures that help them diagnose and treat rheumatic conditions.
These procedures include:
A rheumatologist usually performs a complete physical exam when they see a person for the first time or when they want to monitor the effects of a current treatment regimen.
During a physical exam, a rheumatologist will assess the person’s overall physical condition by checking their pulse, listening to their lungs and heart, and feeling for swollen lymph nodes.
They will spend extra time examining the areas where people report feeling pain or stiffness. They might ask a person to bend, flex, or stretch these areas. They will also look at the joints on both sides of the body to compare size, intensity of inflammation, range of motion, and function.
Arthritis can affect one or more joints, with some people experiencing symptoms on one side of the body and others noticing pain and stiffness on both sides of the body.
A rheumatologist will also review a person’s medical history, current medical conditions, and family history during this comprehensive examination and ask questions to identify other related symptoms they may be experiencing.
Rheumatologists diagnose systemic inflammatory diseases and musculoskeletal conditions. They use a variety of tests to identify the underlying cause of a person’s symptoms.
Some potential causes of inflammation
- environmental exposures
- autoimmune conditions
- abnormal uric acid metabolism
A rheumatologist can also diagnose conditions that cause bone or cartilage loss, including osteoporosis and osteoarthritis.
A primary care physician or rheumatologist can use different imaging tests to look for signs of joint damage. Some imaging tests that they might conduct include:
Laboratory testing involves taking blood, urine, skin, or joint fluid samples for further analysis.
A rheumatologist can use lab test results to identify signs of inflammation and infections, such as higher-than-normal levels of inflammatory reactants, antibodies, or white blood cells.
They can also perform tests to look for specific genetic markers that may increase the person’s risk of specific autoimmune or inflammatory conditions.
For instance, according to the ACR, about 60–70% of people with European ancestry and rheumatoid arthritis carry a gene called HLA-DR4. The HLA system regulates the immune system.
In recent years, researchers have also discovered several genetic markers associated with ankylosing spondylitis. These include HLA-B27, ARTS 1, and IL23R.
Rheumatologists can suggest and provide treatments for many rheumatic conditions. They can also offer consultation on many cases.
Treatments that they may recommend can include the following:
Joint injections and aspirations
A rheumatologist can treat joint inflammation and pain by injecting an anti-inflammatory medication, such as a corticosteroid, directly into the affected joint, or they can aspirate the joint to relieve pressure.
When a rheumatologist aspirates a joint, they use a needle attached to a syringe to remove the excess joint fluid. They use joint aspiration to reduce joint swelling and pain, but they also analyze the joint fluid as a part of the diagnostic protocol.
A rheumatologist might prescribe disease-modifying antirheumatic drugs (DMARDs). DMARDs lower immune system activity or slow down the progress of rheumatic conditions.
Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen, naproxen, meloxicam, and aspirin — can also help relieve joint inflammation and reduce pain.
Many people experience occasional joint and muscle pain. However, people who notice pain or stiffness that does not improve within a few weeks may wish to consider visiting a primary care physician.
A primary care physician will evaluate a person’s symptoms and decide whether to refer them to a rheumatologist for further examination.
A referral may be necessary when:
- the rheumatologist suspects that a person has a systemic inflammatory condition but wants a second opinion
- the person has symptoms of rheumatism and a family history of rheumatic disease
- the person’s symptoms improve after treatment but return if they stop taking medication
- the person’s symptoms worsen over time or do not respond to treatment
- the person develops unexpected complications, such as unexplained fever, rash, or fatigue
- the person has unusual laboratory test results
A routine appointment with a rheumatologist varies depending on the condition or complaint they are helping to treat. A standard appointment may involve a rheumatologist:
- reviewing a person’s medical and family histories, as well as the results of any previous testing or laboratory work
- performing a physical exam to look for any signs of systemic inflammation
- evaluating posture, movement, and flexibility
- examining any specific joints, muscles, or bones that feel swollen, stiff, or painful
- asking questions about other related symptoms that a person may be experiencing
- ordering blood work or other laboratory tests, such as an X-ray or MRI scan, to provide a clinical diagnosis
- making treatment recommendations or waiting to review the lab work before recommending medications or physical therapy
- providing a clinical outlook, plans of care, and short- and long-term goals
- recommending self-management tips and home exercises
Rheumatologists are medical doctors who specialize in diagnosing and treating rheumatic diseases, including arthritis and autoimmune conditions.
A rheumatologist can diagnose rheumatic conditions by taking a comprehensive medical history, performing a complete physical exam, and examining laboratory and imaging test results.
They can also perform various procedures — including bursal injections, joint injections, and joint aspiration — to help diagnose and treat many conditions.