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William C. Shiel Jr., MD, FACP, FACR

What is a rheumatologist?

A rheumatologist is a medical doctor who specializes in the non-surgical treatment of rheumatic illnesses, especially arthritis.

Rheumatologists have special interests in unexplained rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, autoimmune disease, and anorexia. They often serve as consultants, acting like detectives for other doctors.

Rheumatologists have particular skills in the evaluation of the over 100 forms of arthritis, and have special interest in rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still disease, dermatomyositis, Sjogren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch- Schonlein purpura, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud's disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, and others.

Classical adult rheumatology training includes four years of medical school, one year of internship in internal medicine, two years of internal medicine residency, and two years of rheumatology fellowship. There is a subspecialty board for rheumatology certification, offered by the American Board of Internal Medicine, which can provide board certification to approved rheumatologists.

Pediatric rheumatologists are physicians who specialize in providing comprehensive care to children (as well as their families) with rheumatic diseases, especially arthritis

Pediatric rheumatologists are pediatricians who have completed an additional 2-3 years of specialized training in pediatric rheumatology and are usually board-certified in pediatric rheumatology.

What is arthritis?

Arthritis is a joint disorder featuring inflammation. A joint is an area of the body where two different bones meet. A joint functions to move the body parts connected by its bones. Arthritis literally means inflammation of one or more joints.

Arthritis is frequently accompanied by joint pain. Joint pain is referred to as arthralgia.

There are many forms of arthritis (over one hundred and growing). The forms range from those related to wear and tear of cartilage (such as osteoarthritis) to those associated with inflammation resulting from an over-active immune system (such as rheumatoid arthritis). Together, the many forms of arthritis make up the most common chronic illness in the United States.

The causes of arthritis depend on the form of arthritis. Causes include injury (leading to osteoarthritis), abnormal metabolism (such as gout and pseudogout), inheritance, infections, and for unclear reasons (such as rheumatoid arthritis and systemic lupus erythematosus).

Arthritis is classified as one of the rheumatic diseases. These are conditions that are different individual illnesses, with differing features, treatments, complications, and prognosis. They are similar in that they have a tendency to affect the joints, muscles, ligaments, cartilage, tendons, and many have the potential to affect internal body areas.

What are symptoms of arthritis?

Symptoms of arthritis include pain and limited function of joints. Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warm. Tenderness of the inflamed joint can be present.

Many of the forms of arthritis, because they are rheumatic diseases, can involve symptoms affecting various organs of the body that do not directly involve the joints. Therefore, symptoms in some patients with arthritis can also include nonspecific fever, weight loss, fatigue, and feeling unwell.

Who is affected by arthritis?

Arthritis sufferers include men and women, children and adults. Approximately 350 million people worldwide have arthritis. Nearly 40 million persons in the United States are affected by arthritis, including over a quarter million children!

More than 21 million Americans have osteoarthritis. Approximately 2.1 million Americans suffer from rheumatoid arthritis.

More than half of those with arthritis are under 65 years of age. Nearly 60% of Americans with arthritis are women.

How is arthritis diagnosed and why is a diagnosis important?

The first step in the diagnosis of arthritis is a meeting between the doctor and the patient. The doctor will review the history of symptoms, examine the joints for inflammation and deformity, as well as ask questions about or examine other parts of the body for inflammation or signs of diseases that can affect other body areas. Furthermore, certain blood, urine, joint fluid and/or x-ray tests might be ordered. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and any blood and x-ray findings. Several visits may be necessary before the doctor can be certain of the diagnosis. A doctor with special training in arthritis and related diseases is called a rheumatologist (see below).

Many forms of arthritis are more of an annoyance than serious. However, millions of patients suffer daily with pain and disability from arthritis or its complications.

Earlier and accurate diagnosis can help to prevent irreversible damage and disability. Properly guided programs of exercise and rest, medications, physical therapy, and surgery options can idealize long-term outcomes for arthritis patients.

It should be noted that both before and especially after the diagnosis of arthritis communication with the treating doctor is essential for optimal health. This is important from the standpoint of the doctor, so that he/she can be aware of the vagaries of the patient's symptoms as well as their tolerance to and acceptance of treatments. It is important from the standpoint of patients, so that they can be assured that they have an understanding of the diagnosis and how the condition does and might affect them. It is also crucial for the safe use of medications.

What is the national financial impact of arthritis?

It has been estimated that the total cost of the arthritis bill for the United States, in terms of hospitalization, doctor visits, medications, physical therapies, nursing home care, lost wages, early death, and family discord is over $50 BILLION dollars annually.

This does not include the nearly $2 billion spent each year in the United States on unproven remedies by patients addressing their symptoms on their own.

What is a rheumatologist?

A rheumatologist is a medical doctor who specializes in the non-surgical treatment of rheumatic illnesses, especially arthritis.

Rheumatologists have special interests in unexplained rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, autoimmune disease, and anorexia. They often serve as consultants, acting like detectives for other doctors.

Rheumatologists have particular skills in the evaluation of the over 100 forms of arthritis, and have special interest in rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still disease, dermatomyositis, Sjogren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch- Schonlein purpura, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud's disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, and others.

Classical adult rheumatology training includes four years of medical school, one year of internship in internal medicine, two years of internal medicine residency, and two years of rheumatology fellowship. There is a subspecialty board for rheumatology certification, offered by the American Board of Internal Medicine, which can provide board certification to approved rheumatologists.

Pediatric rheumatologists are physicians who specialize in providing comprehensive care to children (as well as their families) with rheumatic diseases, especially arthritis

Pediatric rheumatologists are pediatricians who have completed an additional 2-3 years of specialized training in pediatric rheumatology and are usually board-certified in pediatric rheumatology.

What is the arthritis foundation?

The Arthritis Foundation is the only national voluntary health organization whose purpose is directed solely to all forms of arthritis. The Arthritis Foundation has national and international programs involving support for scientific research, public information amd education for affected patients and their families, training of specialists, public awareness, and local community assistance.

Local branch chapters of the Arthritis Foundation serve to disseminate information about arthritis and rheumatic diseases as well as functioning as referral centers.

Summary and Arthritis at a glance

Summary

It is the ultimate goal of scientific arthritis research that the optimal treatment programs are designed for each form of arthritis. This field will continue to evolve.

Specific information about the different forms of arthritis and treatments can be easily accessed through this forum by clicking on "Related Diseases & Conditions."

Arthritis at a glance

  • Arthritis is inflammation of one or more joints.
  • Symptoms of arthritis include pain and limited function of joints.
  • Arthritis sufferers include men and women, children and adults.
  • A rheumatologist is a medical arthritis specialist.
  • Earlier and accurate diagnosis can help to prevent irreversible damage and disability.

Author: William C. Shiel Jr., MD, FACP, FACR

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