What is a Rheumatologist?
Many people who are referred to see a rheumatologist for the first time may not know much about this medical specialty. Here we briefly explain what the specialty of rheumatology involves, what rheumatologists do, and what to expect when you see a rheumatologist.
A rheumatologist is a specialist physician who has expertise in diagnosing and treating arthritis and other musculoskeletal conditions and autoimmune diseases.
Arthritis mainly affects the joints while other musculoskeletal conditions can also affect the joints, bones, muscles, tendons and ligaments. Autoimmune diseases also commonly affect the musculoskeletal system but many of the conditions rheumatologists treat may affect the rest of the body, including eyes, skin, internal organs and the nervous system.
Rheumatologists are experts in treating the many different types of arthritis and other musculoskeletal conditions including:
- Osteoarthritis, which most commonly occurs in the hands, hips, knees or feet
- Gout ,which most commonly affects the big toe but can also affect other joints such as knees and hands
- Osteoporosis,which increases the risk of broken bones
- Pain that affects one or more specific parts of the body, most commonly the low back, neck, shoulder, hip, and foot
- Generalised pain conditions (e.g. fibromyalgia)
They also diagnose and treat autoimmune diseases including:
- Rheumatoid arthritis
- Psoriatic arthritis, a type of arthritis that occurs in people with psoriasis
- Ankylosing Spondylitis, which most commonly affects the back
- Reactive Arthritis, which most commonly occurs in young adults after an infection
- Lupus (Systemic Lupus Erythematosus, SLE)
- Scleroderma, which affects the skin, blood vessels (Raynaud’s phenomenon) and may affect the kidneys, lungs and other organs
- Sjogren’s syndrome which commonly causes dry eyes and dry mouth
- Myositis, which involves inflammation in the muscles
Some rheumatologists will also have interests or specific experience in certain areas. In particular there are also paediatric rheumatologists who see patients younger than 18 years of age. Conditions in children and adolescents are often quite different from adult conditions and require particular expertise.
For a more extensive list please see the Arthritis Australia website.
Rheumatologists in Australia undertake at least six years of specialist training after completing their medical degree and hospital internship. This includes physician training and specialist training in rheumatology. Your rheumatologist is specially trained to do the detective work necessary to discover the cause of your symptoms. He or she will usually ask you to explain the history of the problem and will undertake a physical examination. Additional investigations such as blood tests, X-rays and scans may also be needed.
Information and Advice
Once a diagnosis is made, your rheumatologist will explain the nature of your illness and what you might expect in the future. This is an important step, particularly for illnesses that might affect you over a long period.
Your rheumatologist is an expert in the comprehensive and holistic management of the whole person. With an accurate diagnosis and a shared understanding of your illness, you and your rheumatologist can work together to design a treatment program aimed at managing pain, reducing inflammation and ensuring your quality of life.
Depending on the nature of your illness, you may need to see your rheumatologist regularly for ongoing management. Some specialised medications can only be prescribed by a rheumatologist. Alternatively you may be treated by your GP, with the rheumatologist on hand for specialist advice.
So how will my condition be treated?
As your rheumatologist will explain, there are a number of treatment options available including:
- Physical therapy
He or she will advise you on the different options and what may be best for you. This will depend on the exact nature of your illness, your circumstances and preferences, and any other individual needs or problems. It is important that you share your concerns with your rheumatologist so that together you can agree on the best approach for you.
In treating and managing your illness, your rheumatologist will work closely with your General Practitioner, to ensure that you receive the best possible care. Other skilled professionals may also share in your care:
- The physiotherapist is trained in the physical treatment of arthritis and musculoskeletal conditions and uses a combination of education and advice, exercise and special treatment techniques.
- The exercise physiologist is trained in delivery of exercise programs.
- The occupational therapist provides advice on how to get on with day-to-day activities such as working, dressing and getting out and about.
- The psychologist or social worker offers advice and support to help patients and families cope with the changes that illness might bring.
- Nurses, podiatrists and dietitians may also form part of the team involved in your treatment.
- If you need surgery for your condition, your rheumatologist will involve an orthopaedic surgeon or sometimes other types of surgeons depending upon the problem.
Advice for your first visit with a Rheumatologist
You will need a referral from your General Practitioner to make an appointment with a rheumatologist (whether in private practice or public hospital outpatient clinic). Please bring a copy of the referral, a health summary, your list of medications, your family history (including information about relatives with rheumatologic/autoimmune conditions), and previous relevant tests and X-rays or other imaging tests if available. A supportive friend or relative would be welcome, as many issues may be discussed.
In Australia, if you have a Medicare card, costs to see a rheumatologist are subsidised but often there is a gap in private practice and this differs in different areas. Please ring the practice directly for costs. If there are concerns regarding out of pocket costs, most large public hospitals have rheumatology clinics that are free of charge to Medicare card holders.