Common Grounds for Rheumatologist

Sep 18, 2018 | Articles

The Specialist Orthopaedic Surgeon and the Rheumatologist Share Common Ground

Just as optometrists and ophthalmologists are both medically qualified professionals who share the common purpose of treating conditions affecting the eyes, the role of the orthopaedic specialist and that of the rheumatologist also tend to overlap. In each case, these healthcare professionals share an interest in the same anatomical structures, but differ in the type of anomalies they treat and in the methods of treatment they are required to employ. The anatomical structure that concerns them both is the musculoskeletal system. Further commonality can be seen in the fact that their services are generally recruited to investigate joint pain, for which either may be called upon to employ surgical or non-surgical treatments, as appropriate.

In practice, there are times when it may be more convenient for an orthopaedic surgeon to perform surgical procedures normally conducted by rheumatologists. In fact, this specialist type of rheumatoid surgery is actually considered to be a sub-field of orthopaedics and emerged from the cooperation of the two disciplines during the ‘50s. Surgical interventions of this type fall into two categories; they may either be preventative or corrective. An example of a preventative procedure is the synovectomy. This involves the removal of the inflamed synovial tissue in the region of the affected joint, in order to prevent its continued spread which, if left untreated, could result in damage to the bones in the joint. Most commonly, a synovectomy is performed on the knee, but it may also be used to treat the shoulder, elbow, wrist, hip, or ankle.

When it comes to corrective procedures, although often consulted, rheumatologists will generally not be involved in the surgery. Instead, an orthopaedic specialist will be the one responsible for undertaking any form of surgical intervention. This might, for example, involve the total or partial replacement of a joint, the use of arthroscopy to remove loose fragments of cartilage or bone, or employing some procedure to correct the alignment or improve the stability of a joint.

As mentioned earlier, painful, swollen joints, often accompanied by impaired mobility, are the symptoms that usually prompt patients to consult one or the other of these two healthcare professionals. While fractures, dislocations, and similar traumatic injuries, and the erosion of joints resulting from osteoarthritis tend to be more the province of an orthopaedic surgeon, the specialist interest of rheumatologists lies in conditions such as gout, tennis-elbow, carpal-tunnel syndrome, osteoporosis, and systemic autoimmune diseases that, like rheumatoid arthritis, can affect multiple joints. In general, it is medication, rather than surgery, that tends to be the principal form of intervention in rheumatology.

So how can a patient be sure which of these two medical experts he or she may need to consult? It’s not possible to be pedantic, but the following guidelines could help. Joint pain is invariably the common driver, so it will be other symptoms or circumstances that will be the decider.

Where multiple joints are affected, there has been no injury, and it is accompanied by sweating, fever, psoriasis or a rash, or it follows a tick bite, a rheumatologist should be the specialist to approach. For isolated joint or musculoskeletal pain following injury, or that worsens progressively and intensifies under load, contact an orthopaedic surgeon.