The field of rheumatology can be a little confusing, because it covers a variety of problems that don’t seem to be related at first glance. Arthritis, autoimmune diseases, lupus, and chronic pain disorders sound almost like a grab bag of disorders and health problems that should be under the care of a variety of different doctors. However, once we dive deeper into what a rheumatologist does, and what causes many of the problems that a rheumatologist treats, you may find that a visit to a rheumatologist is exactly what you need.
We’ll look at all the aspects of rheumatology, including how it is, in fact, a unified field of medicine; how rheumatologists get their training, and how they use that expertise to diagnose and treat conditions; how you can make your first rheumatology appointment more successful; and a few tips for choosing the best rheumatologist for you. We’ll also discuss the signs that indicate that you should consider seeing a rheumatologist.
Rheumatism and the Immune System
To understand what a rheumatologist is, first we must understand what it is that they treat. Rheumatism is an umbrella term that covers all conditions that lead to chronic pain. This is most often related to joint and connective tissue pain, which is why so many people think of rheumatologists as doctors who treat arthritis.
But the fact is that there are a huge variety of diseases and health problems that cause chronic pain, and in fact, treatment of rheumatism is more related to the immune system than to disorders such as osteoarthritis, which are more caused by daily wear and tear on your joints. For this reason, it’s easier to understand a rheumatologist as a doctor who received special training in treating chronic pain conditions related to a weakened or compromised immune system.
Rheumatologist Training and Expertise
Rheumatologists begin their training similar to other physicians: they spend at least four years in medical school, followed by at least three years of residency training (most follow the path of either internal medicine, or pediatrics if they intend to go into pediatric rheumatology). But then, rheumatologists must follow that process with an additional two to three years of fellowship training where they become experts in the diagnosis of, and treatment of, musculoskeletal and autoimmune conditions.
When a patient is experiencing chronic pain that can’t be explained by other medical conditions, a rheumatologist will act as a detective, helping to pinpoint an immune system disorder or a musculoskeletal problem, that may be causing the pain. They’ll start with a list of questions about your symptoms, your medical history, your family history, what types of food or activities make you feel better or worse, and a wide variety of others. Then they’ll perform a physical exam that may include drawing blood or joint fluid, X-rays, MRIs, ultrasounds, and other tests to give them as much information about your body as they can get. Through all of these tests, questions, exams, and their own expertise, a rheumatologist may be able to get to the bottom of a chronic pain condition.
When to Consider a Rheumatologist
So now that you understand what a rheumatologist does, and what the medical field of rheumatology addresses, you may wonder if or when you should consider seeing a rheumatologist. There are a few easy markers that make it a no-brainer to see a rheumatologist, which include:
- Ask your primary care physician if he/she can refer you.
- Being diagnosed with arthritis, lupus, gout, Sjogren’s syndrome, vasculitis, APS, myositis, or other rheumatic diseases – In these cases, the doctor who suspects that you have one of these diseases will refer you to a rheumatologist for an official diagnosis.
- If you have pain or swelling in your joints that isn’t related to a recent injury – This could be a sign of arthritis or other rheumatic disease, and it’s always best to get an evaluation as soon as possible. Early diagnosis offers the best chances for treatment and recovery, so don’t be afraid to contact a rheumatologist if you have unexplained joint swelling or pain.
- If you had an abnormal blood test – This could be an indicator of an autoimmune disease, and in this case, the doctor who ordered the blood test would refer you to a rheumatologist for further testing.
However, there are some other situations that may prompt a visit to a rheumatologist that aren’t so cut and dry. They all boil down to having trouble finding the cause for your chronic pain. Because the list of diseases that rheumatologists treat is so long, and includes so many rare disorders, it’s hard for a doctor to say that rheumatism is precisely the cause of your chronic pain; however, if you have seen many other specialists without a solid answer regarding the cause of your symptoms, or your current treatment simply isn’t working, seeing a rheumatologist should be high on your list of next steps.
Tips for Your First Rheumatology Appointment
When you first see a rheumatologist, you already know that they’ll spend this time gathering information through questions, tests, and exams. But there are things that you can do ahead of time to make the process faster, and some things that you can do to make your visit more successful for your health.
- Be sure that you have a detailed history of your symptoms. Include how long you’ve been in pain, where it occurs, how it feels (stabbing, throbbing, etc), if it comes and goes, if there are any factors that seem to affect the pain, as well as other symptoms you’ve been experiencing.
- Be sure that you ask any questions that you have about things you can do right now to help your pain. Write your questions down before you enter the appointment so that you can be sure to get as many answers as possible. For example, you may want to ask if there are certain foods or activities you can avoid that will help your symptoms; if there are lifestyle changes you can make, such as taking certain supplements, changing your mattress, or holding off on any attempts to get pregnant for the time being. A rheumatologist can offer some general advice even before they know the exact cause of your pain.
- Don’t try to mask your pain, or present an optimistic picture of your symptoms. Even if you feel great the day of your appointment, be sure that you are presenting an accurate picture of how bad your symptoms can get. This is where keeping a diary of your symptoms can come in very handy, and if you do so, be sure to bring it with you to your appointment.
- You should also be sure to list every single pill, supplement, or other treatment you have tried, or are trying. Even that holistic, all-natural wonder cure you tried out of desperation once should be listed. This can give your rheumatologist a better idea of what hasn’t worked, so that they can focus on prescribing the treatments that will work in the future.
With these things in mind, you can make your first rheumatology visit go much smoother. As you work with your rheumatologist to develop a treatment plan and uncover the root cause of your symptoms, you’ll probably think of more questions along the way. That’s okay! There is a lot to take in when you go to a specialist, and no one could be expected to think of everything in the first appointment.
Just as it would be difficult to create a comprehensive list of everything a rheumatologist treats, it would also be difficult to list all the types of treatments that they may prescribe for a patient. Medications are the first thing that many patients think of, and it is true that rheumatologists can and do prescribe long-term pain medications.
However, that is far from the only option for treating musculoskeletal and/or autoimmune disorders. Physical therapy is an option that many arthritis patients can use to help delay the development of their condition, and this doesn’t always have to be done in an office or with a professional’s help. Other treatments could include injections, preventative lifestyle changes, and even referrals to other specialists if there is a narrower field of medicine that can better treat your diagnosis.
Choosing the Best Rheumatologist
Many patients believe that they must stick with the rheumatologist that their doctor referred them to, but that is not at all the case. In fact, if your diagnosis is a rheumatism-related disease, then choosing the right rheumatologist is a very important decision. This is the doctor who could offer you the diagnosis and treatment that you’ve been looking for for years, or even decades, so why would you just stick with the default doctor you were offered? Unless that doctor happens to be the best choice based on the following tips, don’t be afraid to consider a change.
- Consider factors that will make you the most comfortable. For many chronic pain conditions, you may need to discuss sexual activity or other bodily functions, which may be uncomfortable with a doctor of the opposite gender, for example. Choose someone you feel comfortable speaking with about private matters.
- Research the hospital or clinic where they practice. It’s important to be comfortable in the facility, not only with the doctor you’ll be seeing. You may want to choose a doctor that practices in the most modern facility possible to ensure that you have access to plenty of diagnostic equipment and treatment options.
- Spend some time asking the doctor questions, and pay attention more to the way they answer than what they say (for now). You’ll want to choose a rheumatologist that offers you information in a way that you can understand, but also someone who doesn’t gloss over important information. You need to feel confident that your rheumatologist will present you with all the information and options available so you can be sure to choose the best treatments while you are under their care.
More than likely, once you’ve narrowed down your options based on insurance coverage, convenient location, and your own comfort and confidence in their expertise, you’ll have the perfect rheumatologist picked out. But don’t be afraid to make a switch if you find that your first choice doesn’t work out in the long run.
Rheumatology Improves Life Quality
After learning about rheumatology and its relation to the immune system, how rheumatologists are trained, and what you can expect when working with a rheumatologist, it’s easy to understand how seeing a rheumatologist could have a huge effect on the quality of your life.
If you’ve lived with chronic pain for years, and you’ve never been able to get a proper diagnosis, or a good treatment, the rheumatologist could be the answer you’ve been looking for. Worse still, if you’ve been told that the pain was in your head, or that you just needed to “deal with it”, the rheumatologist can offer you the medical proof you need to start trusting your own intuition and your body’s signals again.
If you have developed arthritis due to age or because of a genetic condition, you don’t have to live in pain. Many people believe that arthritis is just a part of getting older, and struggle through the pain every day, bemoaning the fact that they are just getting older. But living in extreme pain, even in your elderly years, is not normal. A rheumatologist can give you the treatment you need to get your joints working properly, and with less pain.
Even if your doctor hasn’t offered you a referral to a rheumatologist, you can still make an appointment to see one yourself. While many, if not most, appointments with specialists such as rheumatologists are made via referrals from other medical professionals, there is nothing stopping you from taking your health into your own hands. Once you’ve identified the rheumatologist you are interested in working with, you can set up an appointment and get on your way to discovering the root cause of your chronic pain.