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A rheumatologist is a specialist physician who trains in the management of rheumatic diseases, which are mostly autoimmune conditions. This article will discuss the training these specialists receive and also what their schedules consist of.

A rheumatologist is a medical specialist who focuses on the diagnosis and management of rheumatic diseases that affect the joints, connective tissue, blood vessels and soft tissue. Rheumatic diseases and conditions are mostly linked to autoimmune dysfunction that affect the mentioned areas of the body and cause problems such as arthritis and vasculitis.

Training

In order for a doctor to specialise as a rheumatologist they must complete their undergraduate medical degree, that takes 5-6 years to accomplish, in order to become a medical doctor in the first place. The doctor then has to complete 1-2 years of internship training where they work at different surgical and medical disciplines to gain clinical exposure. The doctor is then qualified to specialise further and has to complete a 4 year residency programme in internal medicine and, thereafter, takes part in a fellowship training programme in rheumatology that takes 2-3 to complete.

Rheumatologists are also involved in research studies that are looking into newer medications, called biologicals, that are showing to be very effective in the management of rheumatic conditions.

Diseases managed by Rheumatologists

The conditions and diseases that are diagnosed and managed by rheumatologists include:

Inflammatory arthropathies

  • Rheumatoid arthritis.
  • Spondyloarthropathies such as reactive arthritis, psoriatic arthropathy, ankylosing spondylitis and enteropathic arthropathy.
  • Crystal arthropathies sucha as gout and pseudogout.
  • Juvenile Idiopathic Arthritis (JIA).
  • Septic arthritis.

Degenerative arthropathies

  • Osteoarthritis.

Connective tissue diseases and systemic conditions

  • Lupus
  • Polymyositis
  • Sjögren's syndrome
  • Dermatomyositis
  • Scleroderma
  • Mixed connective tissue disease
  • Polymyalgia rheumatica
  • Adult-onset Still's disease
  • Relapsing polychondritis
  • Fibromyalgia
  • Sarcoidosis

Vasculitic conditions

  • Microscopic polyangiitis.
  • Granulomatosis with polyangiitis (previously called Wegener's granulomatosis).
  • Eosinophilic granulomatosis with polyangiitis (previously called Churg–Strauss Syndrome).
  • Henoch–Schönlein purpura.
  • Polyarteritis nodosa.
  • Giant cell arteritis (temporal arteritis).
  • Serum sickness.
  • Behçet's syndrome.
  • Takayasu's arteritis.
  • Buerger's disease (thromboangiitis obliterans)
  • Kawasaki's disease (mucocutaneous lymph node syndrome)
  • Hereditary periodic fever syndromes

Soft tissue rheumatism

The following are local lesions and diseases that affect the joints and the structures around the joints including the ligaments, tendons, ligaments capsules, muscles, bursae, nerves, ganglia and vascular anatomy. 

  • Lower back pain due to issues like sacro-iliitis.
  • Olecranon bursitis.
  • Golfer's elbow.
  • Tennis elbow.

Diagnostic procedures performed by Rheumatologists

A comprehensive history is taken by the rheumatologist that includes a family history, information regarding the patients previous and current occupations, surgical and medical history and information regarding acute and chronic medication use. The rheumatologist will then conduct a physical examination that includes performing tests that are complex and can only be performed by these specialists. These will be discussed as follows:

Physical examination

  • Multiple joint inspection is done on the patient.
  • Schober's test examines the flexion of the lower back.
  • Musculoskeletal examination:
    1. Screening Musculoskeletal Exam (SMSE) - this is a rapid assessment of the function and structure of the joints and muscles.
    2. General Musculoskeletal Exam (GMSE) - the rheumatologist performs a comprehensive assessment of joint inflammation here.
    3. Regional Musculoskeletal Exam (RMSE) - this is a focused assessments of inflammation, function and structure of the joints and muscles combined with specialized investigations.

Specialized investigations

  • Blood tests such as a full blood count (FBC), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), serum uric acid (UA), anti-nuclear antibody (ANA) and anti-citrullinated protein antibody (anti-CCP) can be requested.
  • Imaging techniques such as radiographs (X-rays), ultrasounds, CT scans and MRIs are used to investigate affected joints.
  • Fluids aspirated from affected joints are sent to chemical pathology and cytopathology for further analysis.
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