How Do the Services of a Rheumatologist Differ from Orthopaedics?
It is fairly common for almost anyone to experience pain in a joint, bone, tendon, ligament, or muscle at some time or another. Often, it will have occurred as the result of unaccustomed or overly-strenuous exercise, or a minor trauma. Invariably, the pain recedes within a day or two, and will quickly be forgotten. However, in the event that this type of pain persists for more than a few days, it could be a sign that one may need to seek the services of a rheumatologist.
As a specialist in the diagnosis and treatment of a group of conditions known collectively as rheumatic diseases, the role of these healthcare professionals is closely aligned with that of the orthopaedic doctor in that the focus of both is the musculoskeletal system. Generally, a patient will have been referred to one or the other by a GP. However, because the differential diagnosis of musculoskeletal disorders is not always easy, cross-referrals between the two are sometimes necessary.
Although orthopaedic and rheumatologist services do share some common ground, there are also some distinct differences. While the former may spend much of their time attending to trauma cases involving fractures and dislocated joints, and must frequently undertake an appropriate surgical intervention, the role of the latter is more that of a physician, often calling on other medical experts, such as physiotherapists and psychologists, to assist in the long-term treatment of painful chronic conditions for which surgery would be ineffective.
Many of those patients who are in need of rheumatologist services have some form of autoimmune disorder. These are conditions in which the immune system reacts to one of the body’s tissues as if it were a foreign body. Commonly, one of the tissues associated with a joint is affected leading to pain, swelling, and reduced mobility. The most common of these is rheumatoid arthritis. This condition differs from osteoarthritis in that it tends to affect multiple joints, rather than just a single hip, knee, or shoulder joint as in the latter case.
While, initially, both of these conditions may respond to rheumatologist services, at some stage, a partial or total joint replacement will be the only long-term solution for a patient with osteoarthritis, which will require the attention of an orthopaedic surgeon with extensive experience of the procedure known as arthroplasty.
Other autoimmune rheumatic disorders include systemic sclerosis, spondyloarthropathy, autoimmune myosotis, mixed connective tissue disease, systemic lupus erythematosus and, debatably, fibromyalgia. All of these tend to be referred for the services of a rheumatologist and are likely to be treated mainly with a suitable form of medication, perhaps in conjunction with a remedial exercise programme. To help reduce pain, an anti-inflammatory diet may be recommended, while vaccinations against flu and pneumococcal infection may also be provided, given the heightened risk of infection due to a compromised immune system.
By now it is quite clear that it is important to establish which of these two allied medical disciplines will be the more appropriate for patients who, unfortunately, will often display near-identical symptoms. In practice, the general practitioner will frequently make the correct referral choice. However, either of these specialists is able to quickly differentiate between the need for orthopaedic or rheumatologist services.
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