This is a question that not only patients struggle with but even doctors from other specialties.
The main confusion is between orthopedic surgery and rheumatology specialties.
In general, orthopedic surgeons treat mechanical problems with musculoskeletal system (joints, bones, tendons and ligaments), while the rheumatologists treat all other problems and diseases of this system.
Examples of mechanical problems treated by orthopedic surgeons:
- Sprains of joints like ankle, knee or other joints (twisting the ankle or the knee).
- Fracture of any bone.
- Rupture of a tendon, or ligament.
- Tear of a cartilage (like meniscus tear of the knee).
- Advanced Osteoarthritis (Degenerative Joint Disease/tear and wear arthritis) that requires joint replacement (replacement the original damaged joint with an artificial one) for example of the of the knee or hip.
Examples of non-mechanical issues treated by a rheumatologist:
- Autoimmune Inflammatory arthritis: like Rheumatoid arthritis, Systemic lupus erythematosus and Sjögren’s Syndrome.
- Inflammatory back pain (a wholemark of a group called spondyarthritis), and by inflammatory we mean back pain that gets worse after rest like in the morning or at night, and improves with the moderate activity, as opposed to mechanical back pain that improves with rest.
- Crystal induced arthritis, like gout or pseudogout.
- Mild to moderate osteoarthritis.
- Metabolic bone disease like osteoporosis (weakness of the bones), Vitamin D deficiency and osteomalacia (severe weakness of the bones due to Vitamin D deficiency).
However, there are diseases that can be treated by both specialties, and these are some examples:
- Mild to moderate sprains, not requiring cast or surgery.
- Mild to moderate Osteoarthritis (Degenerative Joint Disease/tear and wear arthritis), that also does not need surgery.
Diseases treated only by a Rheumatologist
Autoimmune and auto inflammatory diseases
The biggest group of diseases that should be treated only by a rheumatologist, is the autoimmune and auto inflammatory diseases.
In this group of diseases there is an inappropriate activation of the immune system, or “confusion” of the immune system, where part of the immune system becomes “confused” and starts “thinking” of the tissues or joints as bacteria.
As a result, the body starts attacking its own tissues and organs and tries to destroy them (because it thinks they are bacteria), and this can result in serious damage and in rare cases even death if left untreated.
The main example of these autoimmune Inflammatory arthritis is Rheumatoid arthritis, which is a disease that affects mainly young adults, and females more than males.
It usually starts in a few small joints of the hands, then progresses over time to involve more and more joints, in general in a symmetric pattern (similar joints on both sides of the body).
If left untreated, Rheumatoid arthritis can cause severe damage of the joints, leading to joints’ deformity and disability within few years.
The good news is that we have very effective treatments for the disease, and we can prevent basically any damage (or any significant damage), especially if the patient presents to us within a few weeks or months from the onset of the symptoms.
The bad news is that many patients arrive late since they start by seeing other specialties (especially orthopedic surgeons), who give them pain killers and other non-effective treatment.
Sadly, some patients prefer to see traditional therapist like Ayurvedic, homeopathy, or herbal that are not effective and may cause serious harm though they claim falsely that their “medicines” are “natural” and “harmless”, but actually they can cause several side effects including serious damage to liver of kidney and we have several cases of serious damage caused by such “treatments.”
So, a significant number of patients arrive late after they already sustained serious damage to their joints, and once damage sits in we cannot reverse it, though we can still slow the progress of the damage.
When we say “slow” because once significant damage is present it starts a vicious cycle.
So, while inflammation caused the initial damage, the damage present now will cause the inflammation to become worse, which in turn worsens the damage more, and so on, and that is why it is very important to see these patients early in the course of the disease before significant damage occurs.
One of the big problems we face is that people think that since the orthopedic surgeon is a “bone” doctor then they should treat Osteoporosis (brittle bones) and that is not correct.
Osteoporosis is a metabolic issue with the bones (not mechanical), so it is the rheumatologists (but also endocrinologists) who have the proper education and experience in treating and monitoring it.
Children with joints’ pain
One important group of diseases that should be referred early to rheumatologists is children with joints’ pain, and this is a tricky group, since most of the young children with arthritis do NOT complain of pain, but they refuse to get up and walk, or refuse to use their hands or arms.
Unfortunately, the family or pediatricians attribute that usually to a fall or injury so children almost always arrive late after significant damage to the joint occurs, or worse a significant damage to eyes since the auto immune arthritis can attack the eyes and can be damaging especially in children.
We have seen serious damage including sadly even blindness due to delay in referral to rheumatologists.
Visit a doctor as early as possible
In summary, you should visit a rheumatologist for any non-mechanical issues (due to injury or trauma) in young adults or children affecting joints, bones, muscles, tendons and ligaments, and in some cases other organs.