What comes to mind when you hear, “rheumatologist”? For many people, perhaps the first thought that pops into their head is rheumatoid arthritis (RA). Or maybe you just think of joint pain in general. And while it’s true that rheumatologists do treat patients with RA and joint pain, they do much more as well.
According to the American College of Rheumatology (ACR), “A rheumatologist is an internist or pediatrician who received further training in the diagnosis (detection) and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic diseases. These diseases can affect the joints, muscles, and bones causing pain, swelling, stiffness, and deformity.”
Everyone experiences joint pain from time to time. So how do you know if your joint pain means it’s time to see a rheumatologist? If you’re feeling new pain, your first visit should be to your primary care physician, who may ultimately refer you for a number of reasons.
Here are four reasons you may see a rheumatologist.
If the Pain in Your Joint(s) is Severe and/or isn’t Improving.
Pain is not uncommon and has many causes. More often than not, you know what’s causing your pain—for instance, if you fall down, bang your elbow, or are recovering from surgery—and the pain resolves on its own or by following instructions from your doctor. Cleveland Clinic defines acute pain as pain that does not last longer than six months. When acute pain resolves, you can continue your life as usual.
But in cases of severe pain where you don’t know the cause, you aren’t experiencing any relief, and the pain is severe, it may be worth looking into further—especially if this pain is new or unusual, or something you haven’t ever experienced before.
If Your Joint Pain is Accompanied by Other Symptoms, such as Sever or Fatigue
Rheumatic diseases often come with other symptoms aside from just joint pain. Osteoarthritis, which is the most common form of arthritis, may present symptoms including:
- Pain during or after movement
- Joint stiffness right after waking up or after inactivity
- Joint tenderness
- Loss of flexibility
- Bone spurs
Similarly, symptoms of RA include tender, warm, swollen joints, as well as joint stiffness upon waking up or after inactivity. However, patients with RA may also experience fatigue, fever, and loss of appetite.
Lupus is a particularly unique disease as it can be characterized by many different symptoms, with no two cases being quite the same. Symptoms that may accompany joint pain, stiffness, and swelling in patients with lupus may include:
- A facial rash that “butterflies” out from the bridge of the nose on the cheeks
- Shortness of breath
- Chest pain
- Dry eyes
- Unexplained rash
- Confusion/memory loss
- Skin lesions that are brought on or worsened by the sun
If You Have Family Members with Rheumatic or Autoimmune Diseases.
Rheumatic diseases may not be hereditary per se, but the combination of having certain genes along with the right environmental triggers may increase your risk for some diseases. A lot of information on this topic has been learned through studying identical and non-identical twins.
For example, the HLA-B27 gene is associated with ankylosing spondylitis (AS). The gene is found in more than 90% of White patients with AS but only 7% of the general population. According to ACR, this means that only about 5% of people with this gene will develop the disease. But first-degree family members of patients with AS who have the HLA-B27 gene have a 20% chance of developing AS themselves—likely due to shared environmental factors as well as other genes they may have inherited that also contribute to AS.
The HLA-DR4 gene is found in 60% to 70% of White patients with RA versus 30% of the general population. In twin studies, 12% to 15% of identical twins, versus 4% of non-identical twins, develop RA; the rate of disease among first-degree relatives of patients with RA is 0.8%, while for the general population, the rate is 0.5%—suggesting that environmental factors likely play a more significant part in developing RA than genetic factors.
For lupus, having a family member with the disease may play a more significant role in risk. One study found that 8% of patients with lupus have at least one first-degree family member with the disease, compared to 0.08% of the general population. In a twin study, when looking at identical twins, SLE recurred in both twins in 24% of cases, compared to 2% in non-identical twins—meaning that genetics and environmental factors may be at play for this disease.
Learn more about genetics and rheumatic and autoimmune diseases here.
If You Suspect Something is Wrong
Everyone feels pain from time to time. It can be caused by so many different things, it feels different for everyone, and there’s often no telling when it will go away. But if something doesn’t feel right—especially if your pain isn’t subsiding with over-the-counter medication or you can’t pinpoint what caused your pain—listen to your intuition.
Even if you’re not completely convinced yourself that the pain may be something more than it seems, it’s better to talk with your doctor than self-diagnose. The longer you wait to get checked out, the more of a chance there may already be damage done to your joints. Also, in some cases, certain treatments are more effective in the early stages of the disease, meaning that the faster you begin your treatment plan, the better off you may be.
For some diseases, there isn’t a specific laboratory test to tell you whether or not you have the condition. In other cases, there’s a lot of overlap of symptoms between one disease and another. And in other cases still, symptoms may vary widely from patient to patient. Therefore, it may sometimes take some time to receive your diagnosis—meaning the earlier you see a rheumatologist, the earlier you can get the process going.