Rheumatologist

What does a rheumatologist do?

A rheumatologist diagnoses diseases and treats patients with degenerative diseases (osteoarthritis), inflammatory arthropathies (rheumatoid arthritis, ankylosing spondylitis (Bechterew’s disease), psoriatic arthritis, juvenile idiopathic arthritis), systemic connective tissue diseases (systemic lupus erythematosus, systemic sclerosis, polymyositis, etc.), vasculitis (autoimmune inflammation of blood vessel walls), and soft tissue rheumatism – local diseases affecting joints and surrounding structures: tendons, ligaments, capsules, muscles, and bones (stress fractures).

A rheumatologist performs a comprehensive examination of the patient, and diagnosis is often time-consuming. Therefore, several visits to the doctor may be required. In order to determine the diagnosis of a rheumatic disease, during the first consultation it is essential for the rheumatologist to clarify the onset, location and progression of symptoms, aggravating and relieving factors, and to determine the relationship of symptoms with psychosocial and risk factors.

For most autoimmune rheumatic diseases, the interaction of hereditary (genetic) factors and environmental factors plays an important role in their development. Therefore, before visiting a doctor, you should consider whether any of these factors may also affect you. Gather information about rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, psoriasis, systemic lupus erythematosus, etc.) that your blood relatives may have suffered from.

Rheumatology includes more than 200 different diseases that affect joints, bones, muscles and soft tissues, including inflammatory arthritis and other autoimmune diseases, vasculitis, soft tissue diseases, back pain, and metabolic bone diseases.

Often, to establish an accurate diagnosis, consultation from doctors of other specialties is also required, for example, a gynecologist or endocrinologist, because most autoimmune rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, scleroderma, etc.) predominantly affect women. This is explained by hormonal changes — both exogenous (oral contraceptives) and endogenous (fluctuations of endogenous hormones during menstruation and pregnancy).

The main feature of modern rheumatology is the discovery of a new group of medications — biological disease-modifying antirheumatic drugs (bDMARDs), which make it possible to achieve the main goal of treating rheumatic diseases: to minimize disease activity or achieve remission. Treatment of rheumatic patients with bDMARDs at the Rheumatology Center of Pauls Stradiņš Clinical University Hospital began in 2007.

Patients with rheumatic diseases must remain under continuous follow-up by a rheumatologist. The doctor should be visited three to four times per year regardless of whether the patient feels well or unwell. It is important to evaluate the effectiveness of treatment and medication side effects.

In fact, a rheumatologist is the family doctor for rheumatic patients. It should be understood that rheumatic diseases require lifelong treatment, and only with the help of a qualified rheumatologist can it be done at a level that ensures long-term remission, delays joint and extra-articular organ damage, and provides the highest possible quality of life. Patients who begin treatment early have a greater chance of achieving remission.

And most importantly — not only the doctor’s experience and ability to diagnose the disease in time are important, but also the patient’s knowledge and willingness to cooperate in order to achieve the best possible way of living with rheumatic diseases.
 

Warning signs when you should see a rheumatologist
 

• Painful and swollen joints (more than one) lasting longer than one week.
• Stiffness after waking up in the small joints of the hands or in the back lasting longer than 30 minutes.
• Pain in the lower back/sacral and/or hip area that wakes you up at night.
• Pain in finger and toe joints that wakes you up at night.
• Swollen fingers or toes.
• Unexplained fatigue even after rest
   

After listening to the patient’s complaints, the doctor chooses the most appropriate and individually tailored diagnostic methods — starting with physical examination, blood tests, and synovial fluid analysis, up to radiological examinations. The doctor may prescribe X-ray, computed tomography (CT), or magnetic resonance imaging (MRI), but in everyday rheumatic disease diagnostics, musculoskeletal ultrasound (US) is increasingly used. It is a safe examination, non-invasive, painless, and does not produce harmful radiation. It is relatively low-cost compared to CT and MRI. It is also suitable for patients with claustrophobia or fear of enclosed spaces.

The quality of the examination depends on the equipment and the specialist’s experience, but its use can be crucial when evaluating prosthetic joints, when MRI is not possible due to the characteristics of the prosthesis material, and CT options have been exhausted or are not available.

In rheumatic joint diseases where joint replacement surgery has been performed, unfortunately the process does not end there — complications are frequent due to both known and previously undetected accompanying diseases. Therefore, ultrasound is an invaluable tool for both rheumatologists and orthopedic traumatologists.

Ultrasound, as a non-invasive method, is also suitable during pregnancy and breastfeeding, for patients with arthritis and other systemic connective tissue diseases, when it is necessary to consider not only the mother’s wellbeing but also the child’s health.

In aggressive arthritis cases with multiple joint deformities, remission may not be achieved during pregnancy, and during lactation an exacerbation of systemic connective tissue disease may occur with polyarticular joint involvement, where musculoskeletal ultrasound is irreplaceable.

Ultrasound allows visualization of changes in tendons, ligaments, and intra-articular (joint) structures. The type of equipment used is extremely important. The latest generation imaging technologies provide excellent image resolution, which is particularly important in joint examinations, because the structures being evaluated are very small — only a few millimeters or even less. Algorithms have been developed to determine in which tissues — joints, tendon sheaths — inflammation is present, to diagnose arthritis, assess treatment effectiveness, and monitor therapy.

An accurate diagnosis helps to choose the most appropriate treatment method to reduce inflammation and prevent progression of joint damage.

Insurance-covered and paid services are available.