This is an important question since we have seen many cases of “arthritis” with delayed diagnosis resulting in damage to the joints and sometimes other organs because patients with arthritis were not directed to the right specialty of rheumatology early in the disease course.
Common Reasons to visit a Rheumatologist
As a general rule any pain, swelling or stiffness of the joints, muscles, or bones that is not due to trauma, should be evaluated by a rheumatologist first, before seeing other specialties.
Other symptoms that are also important include pain or weakness of a muscle, like difficulty combing hair, or climbing stairs, unexplained skin rash, especially if the dermatologist (skin doctor) cannot find a reason for it, unexplained prolonged fever, fatigue, or weight loss especially if the general practitioner cannot find a reason for it. Unusual tightening of the skin, or unexplained hair loss.
Other important manifestation is unexplained “inflammation” of the eyes, especially if the ophthalmologist (eye doctor) cannot find a reason for it, or it keeps recurring.
One reason for the confusion and delay in referrals to rheumatologists is the history of the specialty.
While most of the other specialties (like cardiology for the heart, or nephrology for the kidney), have been established for a very long time, rheumatology is a relatively new specialty to be established as a separate specialty.
Unfortunately, some medical schools still do not include it properly in their curriculum or their training of the new doctors, so many doctors are not familiar enough with this specialty, and some not even aware of it.
As a result, they tend to refer patients with musculoskeletal pain to orthopedic surgeons (instead of rheumatologists), who in many cases do not take the proper step of informing the patient that they should see a rheumatologist instead of themselves.
Another one of the reasons for the confusion about the issue is the confusion about “arthritis” in general, since a lot of people think that “arthritis” or “rheumatism” is a disease of the old age.
What do rheumatologists treat?
While one form of arthritis is actually more common in old age namely the Osteoarthritis (Degenerative Joint Disease/tear and wear arthritis), the more important form is the Inflammatory arthritis.
This is a group of diseases that result in inflammation of the joints that is not due to trauma or injury (or age), and usually starts spontaneously in young adults at the age of twenty to forty, but can also starts in very young children.
This group encompasses many diseases, and it is important to be referred to the rheumatologist early on, because the delay of treatment can result in irreversible damage of the joints, kidney, or eyes, and other important organs or tissues.
These diseases are not due to trauma, or injury, and not due to something the patient did (or did NOT), but they usually happen spontaneously, and mostly are autoimmune where part of the immune system gets confused and starts “thinking” the joints, muscles, skin, or other organs as “bacteria” and starts attacking the body instead or protecting it.
So, any musculoskeletal pain should initially be evaluated by a rheumatologist, preferably within not more than two to three weeks of the onset of symptoms to prevent permanent damage to joints, muscles, or other tissues, especially important organ like the kidney or eyes.
Visiting a rheumatologist early is important
One example of the importance of early referral is a four years old boy that arrived to our clinic with blindness of one eye, and severe inflammation of the other, that is due to childhood onset arthritis (JIA (Juvenile Idiopathic Arthritis)).
Fortunately, we were able to save the other eye so he did not go completely blind, and the joints also were controlled so he did not have significant damage of his joints.
However, has he presented to our clinic when his symptoms started one year earlier, we most likely could have had saved his other eye also.
Another case is of a young lady (sixteen years of age), who was seen by a rheumatologist who made a diagnosis of Systemic lupus erythematosus and started her on treatment.
Someone advised her to see another specialty (orthopedic surgeon) who made the wrong decision of stopping her medicine, resulting in damage to her kidney, severe inflammation around her lung, and a clot of her left arm.
This could have been worse have she not come to our clinic and started proper treatment again.
Take Away Message: You should see a rheumatologist when
So, in summary any symptom affecting the musculoskeletal system (joints, muscles, bones, tendon), that is not a direct result of trauma, or injury (like a fall, or a car accident), should initially be seen by a rheumatologist (the joints doctor), not orthopedic (the bone doctor).
Also, any symptoms affecting other organs, like skin, kidney, eyes, or general symptoms like fever, fatigue, or eight loss, that cannot be explained by other specialties, should be referred to a rheumatologist since some of our disease are called the “great mimickers” since they can resemble other diseases.