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What Are the Most Common Reasons to See a Rheumatologist?

April 4, 2022 - Katie McCallum

If you have pain in your joints that is accompanied by other symptoms, like swelling and fatigue, your doctor may have recommended seeing a rheumatologist.

Your reaction might be to ask a question: What is a rheumatologist?

A rheumatologist is a specialist who diagnoses and treats arthritis and other immune-related diseases and conditions.

Dr. Niharika Ganti, a rheumatologist at Houston Methodist, is here to explain everything you need to know about seeing a rheumatologist, including why your doctor might be referring you to one.

What does a rheumatologist do?

Considered another way, what does a rheumatologist treat exactly?

"Your doctor refers you to a rheumatologist when he or she suspects you have a systemic, autoimmune condition," says Dr. Ganti. "These are diseases in which your immune system is attacking your own body. In the process, inflammation occurs in different organ systems within the body, leading to a variety of symptoms."

The most common reasons to see a rheumatologist include:

  • Rheumatoid arthritis
  • Lupus
  • Osteoarthritis
  • Gout
  • Psoriatic arthritis
  • Sjögren's syndrome
  • Fibromyalgia
  • Vasculitis

And take note, rheumatoid arthritis — one of the conditions most frequently treated by the rheumatologist — isn't the same as osteoarthritis, which also affects the joints and is the commonest kind of arthritis.

"The joint pain associated with osteoarthritis is caused by wear and tear in joints and ligaments," explains Dr. Ganti. "It's degeneration that is mechanical in nature and related to age, injury or repeated stress — and it typically occurs in a particular joint or just a few joints. Rheumatoid arthritis, on the other hand, is characterized by systemic inflammation that causes painful swelling in joints throughout the body."

When should you see a rheumatologist?

As the name implies, systemic autoimmune conditions can affect organs and areas throughout your body, leading to a variety of symptoms.

"These encompass a broad spectrum of conditions that can affect different organ systems, including your musculoskeletal system, skin, kidneys, lungs, nervous system and more — with the joints being the most commonly affected," says Dr. Ganti. "Wherever the immune system is attacking, specifically, is where you will notice the symptoms."

The common symptoms of systemic autoimmune conditions include:

  • Pain, stiffness or swelling in more than one joint
  • Fatigue
  • Generalized weakness
  • Skin rashes or lesions
  • Hair loss

If you notice any of these symptoms, start by consulting your primary care doctor.

"Your doctor can help distinguish if a symptom like joint pain is non-inflammatory and therefore more likely caused by osteoarthritis, or if it's accompanied by other systemic symptoms that may indicate an inflammatory, autoimmune condition," says Dr. Ganti.

In this case, a basic panel of blood tests that look for markers of inflammation will likely be ordered. From there, your doctor will determine whether you need to be referred to a rheumatologist for further evaluation.

What happens at the first appointment with a rheumatologist?

At the first appointment, your rheumatologist will likely order a battery of tests — from extensive blood tests to X-rays — to help identify and rule out the potential causes of your symptoms.

"Most systemic autoimmune conditions are associated with elevated inflammatory markers, so blood tests can give us a clear idea of what's happening in the body and make a diagnosis," says Dr. Ganti.

In some cases, however, the cause of systemic symptoms can't always be identified via blood work.

"Fibromyalgia, in particular, is a diagnosis of exclusion," explains Dr. Ganti. "These are people who present with generalized, chronic joint pain but their inflammatory workup comes back negative — making it more of a clinical diagnosis than one based on blood work."

How does a rheumatologist treat arthritis and other autoimmune conditions?

If you're diagnosed with a rheumatic condition, the primary goal of treatment is to modify the activity of your immune system in order to reduce the inflammation it's causing.

"Immunomodulatory medications and steroids are the mainstay for managing these conditions," says Dr. Ganti. "Lastly, we add in symptomatic treatment with over-the-counter anti-inflammatory medications, such as ibuprofen and acetaminophen, and topical analgesics."

For treatment of advanced or severe conditions, medications that suppress your medications may be needed.

"Your immune system plays otherwise important roles, such as preventing infection — so we don't suppress it unless your condition warrants it," says Dr. Ganti.

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