Rheumatoid arthritis is one of the most well-known rheumatic diseases, and many people mistakenly believe this is a relatively rare condition that primarily affects the elderly. In reality, the Centers for Disease Control reports that 1 in 4 Americans has been diagnosed with a rheumatic disease, and this number is predicted to rise to 78 million US adults by the year 2040. Nearly 8 million adults between the ages of 18-44 have been diagnosed with arthritis and approximately 300,000 children have been diagnosed with juvenile idiopathic arthritis. Because rheumatic diseases can affect patients at any age and in many ways, the rheumatologists who treat these diseases are a vital part of the medical community.

What is Rheumatology?

Rheumatology is the field of medicine that involves the diagnosis and treatment of diseases that affect the joints, bones, and muscles. Rheumatology is similar to orthopedics in that it requires in-depth knowledge of the musculoskeletal system to provide treatment. However, orthopedics focuses more on injuries and surgical treatments, while rheumatology focuses more on rheumatic diseases that are primarily caused by immune system reactions, such as rheumatoid arthritis and lupus. Doctors who treat rheumatic diseases are known as rheumatologists.

What Do Rheumatologists Do?

Rheumatologists study and treat rheumatic diseases, which are musculoskeletal diseases often caused by autoimmune conditions that attack the joints, ligaments, tendons, or muscles. Since these diseases can affect patients in different ways and there are many different types of diseases that fall under the umbrella of rheumatology, doctors must use a variety of tests and treatments to help patients cope with these chronic illnesses.

What can a Rheumatologist Diagnose?

Rheumatologists can treat any musculoskeletal condition or disease that orthopedists treat, but rheumatologists do not perform surgery. Rheumatic specialists will also generally focus on treating rheumatic diseases and leave other musculoskeletal injuries, such as tears in the ligaments or joint replacements, to their orthopedic surgical counterparts.

There are over 100 different rheumatic diseases and conditions, but some of the most common diseases treated by rheumatologists include:
• Osteoarthritis – arthritis caused by the deterioration of cartilage in the joints
• Gout – arthritis caused by uric acid crystallization deposits in the joints
• Rheumatoid arthritis – arthritis caused by an autoimmune condition that attacks the tissues surrounding joints
• Chronic back and neck pain – regular, ongoing pain in the neck or back lasting more than three months
• Sciatica – pain radiating along the sciatic nerve in the lower back, usually caused by pressure on the sciatic nerve
• Carpal Tunnel Syndrome – pain, numbness, and tingling in the hand or wrist caused by pressure on the median nerve, usually from overuse
• Psoriatic arthritis – arthritis occurring in patients who have psoriasis, a chronic, inflammatory skin condition
• Lupus – an autoimmune disease where the body’s immune system attacks tissues and organs
• Sjogren’s syndrome – an autoimmune disease where the body’s immune system attacks the glands that produce tears and saliva, causing dry mouth and dry eyes
• Scleroderma – an autoimmune disease that affects the connective tissues and skin causing hardening, tightness, and pain
• Fibromyalgia – a chronic condition of unknown cause leading to widespread pain, tenderness, fatigue, and sleep problems
• Lyme arthritis – arthritis caused by stiffness and swelling in the joints most commonly experienced during the late stages of lyme disease

What Does a Rheumatologist Test For?

During the first visit with a new patient, rheumatologists will conduct a standard intake visit to get to know the patient’s medical history, current concerns, and recent issues. During this visit, the doctor will take vital signs, look for obvious signs of inflammation or other rheumatic disease indicators, and assess the patient’s joint flexibility and pain levels. The rheumatologist may also request any of the following lab tests:
• Synovial fluid – This test involves aspirating the fluid around a problematic joint to look for calcium pyrophosphate crystals, proteins, or other signs of infection or inflammation.
• C-reactive protein (CRP) – This blood test looks for elevated levels of a specific protein, which help physicians to distinguish between inflammatory and non-inflammatory rheumatic conditions.
• Erythrocyte sedimentation rate (ESR) – This blood test measures the rate at which blood settles to the bottom of a test tube. In patients with high levels of inflammation, blood settles faster.
• Anti-cyclic citrullinated peptide (Anti-CCP) – This blood test looks for the presence of specific antibodies that signal bone damage caused by rheumatoid arthritis.
• Anti-neutrophil cytoplasmic antibodies (ANCA) – This test also looks for specific antibodies that can confirm the suspicion of vasculitis.

In addition to these blood and fluid tests, rheumatologists may request diagnostic imaging scans, such as x-rays, MRIs, or ultrasounds, to look for signs of damage and inflammation and help better diagnose a rheumatic disease.

How to Become a Rheumatologist

The pathway to becoming a rheumatologist begins much like any other medical doctor. Students begin by completing a four-year undergraduate program that will help them prepare for medical school. Although a specifically pre-med program is not required, taking undergraduate courses with a heavy science background will be very helpful in familiarizing students with the inner workings of the human body. After completing their first four years in college, students will go on to receive education and training specific to the field of rheumatology.

Education and Training

During medical school, aspiring rheumatologists will start by following a traditional internal medicine pathway. Students will spend four years in medical school – the first two years will be a mixture of classroom and lab experience, followed by the completion of clinical rotations and preparation for a residency program.
The Accreditation Council for Graduate Medical Education (ACGME) does not offer a specialty specifically in rheumatology. Instead, aspiring rheumatologists will follow a pathway for internal medicine and subspecialize in rheumatology (for adult diseases) or follow a pathway for pediatrics and subspecialize in pediatric rheumatology (for adolescent diseases). To accomplish this, students must complete a 3-year residency program in either internal medicine or pediatrics followed by a 2-3 year fellowship for additional training and research in the field of rheumatology.
After completing 13-14 years of training beyond high school, rheumatologists can become licensed doctors after passing all portions of their state licensing exams. There are also additional certification exams for licensed doctors to become certified in the field of rheumatology.

Rheumatologist Salary Expectations

According to the Medscape Rheumatologist Compensation Report for 2020, rheumatologists can expect to earn $262,000 annually on average. While this salary is on the lower end of the pay scale for physicians across all specialties, rheumatologists do earn more than their counterparts specializing in internal medicine ($251,000 per year) or pediatrics ($232,000 per year). They also out earn doctors working in infectious diseases (averaging $246,000 per year), diabetes & endocrinology (averaging $236,000 per year), family medicine (averaging $234,000 per year), and public health & preventative medicine (averaging $232,000 per year).

Job Outlook and Working Conditions

Rheumatologists are currently in high demand, and the American College of Rheumatology has projected the national shortage of trained rheumatologists to reach 4,133 clinical full-time-equivalent practitioners by 2030. To meet the demand for trained rheumatologists, the workforce would need to more than double in the next 10 years.
Rheumatologists also report a high degree of job satisfaction, in part because the vast number of rheumatic diseases keeps the job intellectually stimulating. The chronic nature of rheumatic diseases also allows practitioners to form close bonds with their patients over longer periods of time. Rheumatologists can work in clinical settings directly caring for patients or in a research capacity studying any of the myriad of diseases that fall under this category. Rheumatologists also have a relatively low number of “emergency” cases compared to other medical fields, so doctors choosing this career pathway can expect fairly consistent working hours.

Frequently Asked Questions

What is the difference between a rheumatologist and an orthopedist?

Although both rheumatology and orthopedic specialists treat the musculoskeletal system, rheumatologists are primarily concerned with chronic diseases that are autoimmune or inflammatory in nature while orthopedists are primarily concerned with illnesses and injuries to the musculoskeletal system that typically require corrective surgery or medical assistive devices. Orthopedists may receive more training in physical therapy and other approaches designed to maximize mobility while rheumatologists may receive more training in pain management and disease identification.

What are some common misconceptions about rheumatic diseases?

The general public may mistakenly believe that rheumatic diseases, such as rheumatoid arthritis or lupus, are simply made up diseases by people who are chronic complainers or have a low threshold for pain. In reality, patients affected by rheumatic diseases experience strong, debilitating symptoms that can affect their ability to work and function normally. These diseases can also manifest differently in individual patients, so rheumatologists should be prepared to investigate and understand each patient’s concerns in order to control pain and symptoms and help maximize quality of life.

How has the field of rheumatology been affected by the COVID-19 pandemic?

Like many medical specialties, the practice of rheumatology has undergone significant changes since the onset of the COVID-19 pandemic. Rheumatologists have changed their practices to include more telemedicine, personal protective equipment (PPE), and health and safety protocols than in years’ past.

But one of the most significant challenges faced by rheumatologists has been the misinformation coming out of pandemic-related research. Since rheumatologists often work with immune-compromised patients, their patients are at a significantly higher risk than other individuals exposed to COVID-19. In addition, many rheumatology patients were taking hydroxychloroquine for their rheumatic diseases before it was ever associated with the treatment of COVID-19. The misinformation concerning the effectiveness of hydroxychloroquine in COVID-19 patients caused medication shortages for those who truly needed it and could benefit from it.

Furthermore, there have been nearly 50,000 medical papers published about the pandemic, and rheumatologists are trying to keep updated on the latest information to help educate their patients. The sheer volume of information, much of which uses faulty or inaccurate methodology, makes it challenging for rheumatologists to help patients navigate their chronic diseases amidst the global pandemic.