What Is a Rheumatologist?

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Overview

A rheumatologist is a physician who specializes in the diagnosis, management, and treatment of rheumatic and musculoskeletal diseases (e.g., arthritis, lupus). Rheumatic diseases are characterized by pain and inflammation in the joints and associated structures, and muscle soreness and stiffness.

There are more than 100 types of rheumatic conditions. Rheumatic diseases are complex and often difficult to diagnose and treat. They may be acute (i.e., have a rapid onset and cause severe symptoms) or chronic (i.e., progress slowly).

Rheumatologists undergo extensive training and are highly qualified in the medical (i.e., nonsurgical) treatment of rheumatic diseases, including the following:

• Arthritis (e.g., rheumatoid, juvenile, infectious)
• Bursitis (inflammation of a fluid-filled sac [bursa]; common in the knees, shoulders, and elbows)
• Degenerative joint disease (osteoarthritis)
• Fibromyalgia (causes chronic muscle and joint pain)
• Gout (metabolic disease that causes acute arthritis and joint inflammation)
• Lupus (systemic lupus erythematosus)
• Lyme disease (transmitted by infected ticks)
• Pseudogout (chronic arthritis similar to gout; common in the knees)
• Spondyloarthropathies (e.g., ankylosing spondylitis, Reiter’s syndrome)
• Tendonitis (inflammation of a tendon, which connects muscle to bone; common in the knees, shoulders, and elbows)

Rheumatologists often work as part of a health care team. In many cases, the rheumatologist advises other physicians and acts as a consultant during diagnosis and treatment. In other cases, the rheumatologist refers the patient to another physician or manages the health care team (e.g., other doctors, nurses, physical and occupational therapists).

During treatment, the rheumatologist assesses systemic involvement, determines the need for orthopedic intervention or hospitalization, and analyzes the results of advanced laboratory tests and radiological examinations (e.g., x-rays, scans). The rheumatologist also evaluates the patient's mental condition and level of independence.

Rheumatologists provide health care in a number of settings, including hospitals (e.g., medical, surgical, rehabilitation), outpatient clinics, and in private practice. Many rheumatologists conduct research to learn more about the causes of rheumatic diseases and develop more effective treatments.

Education
The minimum requirement for acceptance into medical school is 3 years of education at a college or university, but most medical students have an undergraduate (e.g., Bachelor of Science) or advanced degree. Premedical undergraduate study includes biology, English, the humanities, mathematics, physics, social sciences, and inorganic and organic chemistry.

The student must then complete 4 years of medical school and obtain either a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) degree. During the first 2 years of medical school, students take courses in anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and classes in laws governing medicine. They also learn how to perform a medical history, examine patients, and diagnose illnesses.

During the final 2 years of medical school, students care for patients in hospitals and clinics, under the supervision of experienced physicians. In this setting, medical students learn acute, chronic, preventive, and rehabilitative care through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery.

The doctor then must undergo at least 3 years of special study and training, which is called a residency. Rheumatologists complete either a general internal medicine residency or a pediatric residency.

Board Certification
Following his or her residency, the internist or pediatrician who wishes to specialize in rheumatology must complete at least 2 years of study (called a fellowship) in a rheumatology training program. A subspecialty board for rheumatology certification, which is offered by the American Board of Internal Medicine, provides board certification to approved rheumatologists. Most rheumatologists who treat patients are board-certified.

Pediatric rheumatologists specialize in providing comprehensive care to children with rheumatic diseases, especially arthritis. Pediatric rheumatologists have completed an additional 2-3 years of specialized training and are usually board-certified in pediatric rheumatology.

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