Understanding Rheumatology and the role of Rheumatologists

Rheumatology is a medical specialty that focuses on the diagnosis and treatment of conditions affecting the musculoskeletal system, including joints, muscles, bones, and connective tissues. Rheumatology doctors are known as rheumatologists and are specialized physicians who are experts in managing a wide range of rheumatic diseases.

Rheumatologists or rheumatology doctors are medical specialists who diagnose, treat, and manage conditions that affect the musculoskeletal system, including joints, muscles, bones, and connective tissues. Rheumatology specialists help to diagnose, treat, and manage certain musculoskeletal conditions that fall within the autoimmune disease category. They undergo comprehensive evaluations such as a medical history, physical examination, and diagnostic tests, to diagnose rheumatic diseases and differentiate them from other conditions.

Rheumatologists develop personalized treatment plans, often utilizing medications, physical therapy, and lifestyle modifications to control inflammation, relieve pain, and slow disease progression. They monitor disease progression, make necessary treatment adjustments, and educate patients about their conditions. Collaborating with other healthcare professionals, such as orthopedic surgeons and therapists, they provide comprehensive care. Rheumatologists stay updated on research advancements and contribute to advancing knowledge in the field. Their goal is to improve patients’ quality of life, reduce pain, and preserve joint function, enabling individuals with rheumatic conditions to better manage their overall well-being.

Some of the more common conditions that rheumatologists treat include:

• Rheumatoid arthritis (RA)
• Osteoarthritis (OA)
• Lupus (Systemic Lupus Erythematosus)
• Spondyloarthropathies
• Gout
• Fibromyalgia
• Vasculitis
• Sjögren’s syndrome
• Polymyalgia rheumatica
• Lyme Disease
• Ehlers-Danlos Syndrome
• Connective tissue diseases (such as systemic sclerosis, dermatomyositis, and mixed connective tissue disease that involve inflammation and damage to connective tissues)

Rheumatologists also provide care for other less common rheumatic conditions and collaborate with other specialists to address related complications.

Rheumatology specialists perform various tests and procedures to aid in the diagnosis and management of rheumatic conditions. The specific tests and procedures conducted by rheumatologists depend on the individual patient’s symptoms, medical history, and suspected diagnosis. They aim to gather relevant information to make an accurate diagnosis and develop an effective treatment plan. Here are some common tests and procedures conducted by rheumatologists:

• Physical examination
• Blood tests
• Imaging tests such as X‑rays, ultrasounds, or magnetic resonance imaging (MRI) scans
• Joint aspiration/​synovial fluid analysis
• Musculoskeletal ultrasound
• Biopsies
• Bone density scan (DXA scan)

You should consider seeing a rheumatologist for the following situations:

• Persistent joint pain
• Joint swelling or stiffness
• Autoimmune conditions (such as rheumatoid arthritis, lupus, or psoriatic arthritis)
• Systemic symptoms ( such as unexplained fatigue, fevers and weight loss)
• Suspected or confirmed connective tissue diseases
• Complex or undiagnosed conditions
• Persistent and abnormal skin rashes or lesions
• Unexplained hair loss

Referral from a primary care physician: If your primary care physician suspects a rheumatic condition or recommends a rheumatology evaluation based on your symptoms and medical history, it is important to follow their recommendation and seek a rheumatologist’s expertise.

It is always best to consult with your primary care physician first, as they can assess your symptoms, perform initial evaluations, and refer you to a rheumatologist if necessary based on their clinical judgment.

During your first rheumatology appointment, here is a few common steps that your doctor may perform:

• Medical history review. The rheumatologist will begin by reviewing your medical history, including any previous diagnoses, medications, surgeries, and relevant family medical history. They may ask detailed questions about your symptoms, their duration, and any factors that may worsen or alleviate them.
• Physical examination. A thorough physical examination will be conducted, focusing on the joints, muscles, and other areas of concern. The rheumatologist will assess your range of motion, joint tenderness, swelling, and signs of inflammation.
• Diagnostic tests. Based on your symptoms and physical examination, the rheumatologist may order diagnostic tests, such as blood work or medical imaging.
• Discussion and evaluation. The rheumatologist will discuss their initial impressions, potential diagnoses, and any further testing or evaluations needed to confirm or rule out specific conditions. They will explain the reasoning behind their recommendations and address any questions or concerns you may have.
• Treatment plan. If a diagnosis is made, the rheumatologist will develop an individualized treatment plan tailored to your specific condition. This may involve medications, physical therapy, lifestyle modifications, and other interventions aimed at managing symptoms, slowing disease progression, and improving your quality of life.
• Follow-up appointments. The rheumatologist will schedule follow-up appointments to monitor your progress, adjust treatment plans as needed, and provide ongoing care and support.

It’s important to actively participate in the appointment by providing accurate and detailed information about your symptoms and medical history. Prepare a list of questions or concerns you may have to ensure all your queries are addressed. The first appointment is an opportunity for the rheumatologist to gather information and begin developing a comprehensive understanding of your condition, ultimately leading to an appropriate treatment plan.

For a rheumatology appointment, it is best to wear comfortable and loose-fitting clothing that allows easy access to the areas of concern. Opt for clothing that can be easily removed or adjusted, as you may need to change into a gown or expose specific areas for examination. Choose shoes that are easy to take off and put back on, particularly if the rheumatologist needs to evaluate your feet or lower extremities. Avoid excessive jewelry or accessories that could interfere with physical examinations or imaging procedures. It is always a good idea to contact the clinic beforehand for any specific clothing instructions or guidelines.

It’s important to find the right rheumatologist for you that will help you understand how certain conditions can impact your life as well as how to prevent and manage them. As part of your care team, Oak Street Health’s rheumatologists work closely with your Oak Street Health primary care doctor to diagnose and treat your rheumatoid condition.

Medicare and other different insurance plans usually require you to select a primary care doctor. Some rheumatology services my have extra costs associated with them, so to avoid excessive fees make sure that you:

• Contact your insurance provider to make sure that the rheumatologist and services are within your insurance network.
• Contact the doctor’s office to check whether they accept your insurance.
• Ask your doctor about the costs of services and tests before agreeing to them.