What is a rheumatologist and what do they do?

One of the most important decisions you will make during your medical school education is choosing which specialty to follow. Making this choice involves many contributing factors, including your personal history, clinical interests, experience, how long the training involved takes, and financial and lifestyle considerations.

Rheumatology is an exciting medical specialty that treats a wide range of medical conditions. If you decide to pursue it, you’ll be working towards an exciting and rewarding career path.

What is a rheumatologist? 

A rheumatologist is an internal medicine physician trained in the diagnosis and treatment of inflammatory diseases that affect the muscles, bones, joints, ligaments, and tendons. Rheumatoid diseases can cause pain, swelling, and stiffness, with extreme cases potentially leading to joint deformities. Rheumatologists also diagnose and treat musculoskeletal conditions but do not perform surgery in these instances. Their job is to treat disease using nonsurgical methods. Common illnesses treated by rheumatologists include:

•     Inflammatory joint disease
•     Degenerative joint disease
•     Autoimmune disease
•     Back problems
•     Soft tissue disorders,
•     Metabolic bone disorders,
•     Crystal arthropathies
•     Musculoskeletal infections

Many rheumatologists also develop sub-specialty interests further into their career, such as:

•     Pediatric rheumatology
•     Metabolic bone disease
•     Sports medicine
•     Autoimmune and inflammatory conditions
•     Noninflammatory degenerative joint conditions
•     Soft tissue diseases
•     Chronic pain

What does a rheumatologist treat?

Rheumatologists treat a group of diseases called ‘systemic autoimmune diseases,’ also known as ‘collagen vascular diseases’ and ‘connective tissue diseases.’ These diseases occur when a person’s immune system attacks their own body. As a result, inflammation occurs in areas of the body where it is not needed. This can cause pain, swelling, and organ damage. These diseases can affect any part of the body, from eyes, skin and nerves through to kidneys, lungs, heart, and other internal organs. All the systemic autoimmune diseases can also cause inflammation of the joints, or arthritis. 

Rheumatologists are considered the experts in treating this group of illnesses. Some examples of systemic autoimmune diseases include rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s disease, scleroderma, and vasculitis. There are more than 100 different types of arthritis and musculoskeletal conditions that we know of — so a rheumatologist’s job is never boring! Many rheumatologists also dedicate their time to researching the causes of and better treatments for the rheumatic diseases they encounter.

The most common procedures and interventions used by rheumatologists are:

•     Physical examination
•     Musculoskeletal ultrasound
•     X-ray and other imaging methods

○      Ultrasound

○      MRI scan

○      CT scan

•     Drug treatments
•     Laboratory tests

○      Environmental exposures

○      Genetics

○      Infections

○      Autoimmune conditions

○      Abnormal uric acid metabolism

•     Soft tissue and joint injections
•     Spinal injections
•     Biopsy procedures

How to become a rheumatologist?  

Rheumatologists must obtain a medical degree. This is then followed by three years of residency training in either pediatrics or internal medicine, and some rheumatologists are trained in both. After finishing residency, they must participate in a rheumatology fellowship for 2 to 3 years to specialize in diagnosing and treating musculoskeletal and autoimmune conditions.

At this point, rheumatologists take an examination that tests their knowledge of rheumatology. Rheumatologists who pass this exam are deemed to be ‘board certified’ and many then decide to participate in a voluntary program coordinated by the American Board of Medical Specialties, called Maintenance of Certification (MOC). The benefit of doing so is to show that they are committed to pursuing better healthcare for their patients, achieving advanced knowledge of their specialty, and committing to lifelong learning in rheumatology.

Rheumatologists are not required to be board certified or part of MOC to practice medicine, but having these designations shows that they are dedicated to continuous improvement and becoming the best rheumatologist they can be. Throughout their career, rheumatologists must take part in classes that cover current medical practices to maintain their medical licenses. These courses are called continuing medical education, or CME for short.

What is the average rheumatologist salary?  

According to the Medscape Rheumatology Compensation Report 2021, rheumatologists reported an increase in average income in 2020, despite the backdrop of COVID-19. Of the rheumatologists that experienced a loss of income due to the pandemic, 4 in 10 expected their income to return to normal this year. Rheumatologists are also reportedly the happiest medical specialists outside of work, according to the Medscape Physician Lifestyle & Happiness Report 2019.

Rheumatologist salaries by percentile

Rheumatologist average salary by State

What is pediatric rheumatology? 

A common subspecialty of rheumatology is pediatric rheumatology. A pediatric rheumatologist is a physician who has received specialized training to diagnose and treat autoimmune conditions that affect children. Common reasons that children are referred to a pediatric rheumatologist include joint swelling and stiffness, persistent unexplained fevers, rashes, weakness, and chronic inflammation. These are often linked to conditions such as juvenile idiopathic arthritis, lupus, scleroderma, dermatomyositis and other forms of muscle inflammation, chronic uveitis, and autoinflammatory syndromes such as PFAPA (Periodic Fever, Aphthous StomatitHis, Pharyngitis, Adenitis) and other periodic fever syndromes.

Pediatric rheumatologists rely on history-taking, examination, and communication with other professionals, as the conditions they manage often do not have specific diagnostic tests.

Pediatric rheumatologists are part of a rapidly developing specialty that encourages a range of clinical and academic interests, including clinical and educational research. They are committed to contributing to collaborative research studies and clinical trials, with the dedicated aim of improving outcomes for children and young people with rheumatological conditions.

To become a pediatric rheumatologist, you must have the following training:

•     At least four years of medical school
•     An additional three years of general pediatric residency training
•     Three years of fellowship training focusing on child and adolescent conditions and illnesses that affect the joints, muscles, bones, or other connective tissues throughout the body
•     Board certification by the American Board of Pediatrics in pediatrics and pediatric rheumatology

For more information on becoming a rheumatologist or further details of any MUA medical course, please get in touch.