Do You Need To See A Rheumatologist For Osteoarthritis?

Osteoarthritis (OA) is a joint disorder that develops when the protective cartilage in the joint wears down over time. It is also known as degenerative joint disease or "wear and tear" arthritis.

OA can begin with joint pain, swelling, or stiffness, which can progress to reduced joint function and mobility, and sometimes disability. The disease mostly affects the older population and is more likely to target joints that bear significant body weight, like the knees and hips.

Here are some of the joints that are most likely to develop OA:

• Knees

• Hips

• Lower back

• Neck

• Hands (ends of fingers and thumbs)

Research reveals that over 50 million US adults suffer from some form of arthritis¹. There are over 100 different types, but osteoarthritis is the most common, affecting nearly 33 million US adults². Although the damage to the joint is irreversible, osteoarthritis symptoms can be managed and the condition can be slowed.

You may have heard of rheumatologists treating people with osteoarthritis. Perhaps you’re wondering if you should see one. Let’s take a closer look at the role of a rheumatologist and how they could help you.

Signs and symptoms of osteoarthritis

Osteoarthritis is a joint disease that affects people differently. Some OA patients experience no limitations in their lives, while others suffer from significant pain and swelling which makes day-to-day life challenging.

Osteoarthritis symptoms develop gradually and tend to worsen over time. Symptoms include:

• Pain — damaged joints may be very painful during or after movement

• Stiffness — most noticeable after waking up or being inactive

• Tenderness — when applying light pressure to or near the joint

• Loss of flexibility — difficulty moving the joint through its full range of motion

• Grating sensation — hearing a popping or crackling sound when you move

• Bone spurs — feeling hard lumps forming around the affected joint

• Swelling — caused by the inflammation or thickening of soft tissue or extra fluid in or around the joint

Muscles around the affected joint may appear wasted or thin, and it could give way when you put weight on it. This happens because the joint structure has become weaker and less stable.

Common causes of OA include aging, obesity, joint injuries and abnormalities, and genetic factors.

Diagnosing osteoarthritis

If you suspect you have arthritis, getting an accurate diagnosis is essential. This is because different forms of arthritis require specific treatments.

Osteoarthritis diagnosis is usually based on:

Symptoms — your doctor will evaluate your symptoms and ask you questions to determine when they began, how they developed, and how they affect your daily life. They will also ask you if any factors make your symptoms worse or more manageable.

Physical examination — your doctor will check for bone spurs, swelling, tenderness, restricted movement, instability, and muscle weakening or thinning. This helps determine if you are suffering from OA, including the severity of your condition.

Your doctor may carry out a blood test to rule out other conditions, and in some cases, they may refer you to a specialist for different tests which may help to identify what is causing your symptoms and determine a suitable treatment plan.

Signs that you need specialist care for osteoarthritis

Arthritis symptoms can be managed with the care of a general physician, but when the disease advances and the treatment options available from your doctor are no longer effective, you may need specialist care.

Your primary care physician may refer you to a rheumatologist if:

• Your pain is persistent

• Symptoms have not subsided and are worsening despite treatment

• Your doctor is unable to diagnose the underlying cause

• Symptoms are spreading more frequently or more severely

• Your disorder is impacting your quality of life

• You are unable to handle everyday tasks

• You are becoming progressively housebound

If your primary care doctor wants to get a second opinion about your condition, they may consult with a rheumatologist to ensure you receive appropriate care.

How can a rheumatologist help?

Unlike your primary care doctor, a rheumatologist specializes in different types of arthritis, including osteoarthritis and other musculoskeletal conditions. If your OA diagnosis is unclear or requires specialist attention, it would be helpful to get the opinion of a rheumatologist.

The rheumatologist can help you with the following:

Comprehensive history and physical examination

A rheumatologist will examine your medical history of arthritis (including the affected joints, progression, impact on daily life, and treatments) and any other symptoms you are experiencing (such as weight loss, night sweats, or preceding infection). They will also look at your family history and any medications you have taken in the past.

They will also perform a complete physical exam on the affected joints. During a physical exam, your rheumatologist may check your skin for nodules which could indicate another type of arthritis — rheumatoid arthritis.

Diagnostic testing

A rheumatologist might perform some diagnostic testing that can help rule out other problems that may be causing your symptoms, such as infections, autoimmune disorders, genetics, and abnormal uric acid metabolism.

Diagnostic testing may also focus on conditions that result in cartilage loss within the joint, or wider problems with your muscles and bones.

Imaging testing

A rheumatologist can perform different imaging tests to your doctor if required. These include CT scans, MRI scans, x-rays, and ultrasounds which can help the rheumatologist to provide an accurate diagnosis.

Lab testing

A rheumatologist may ask for samples of your urine, joint fluid, or blood to perform further analysis. A blood test can help to reveal inflammation and infections. They may also test for specific genetic markers that increase your chances of developing osteoarthritis.

Treating joint inflammation and pain

A rheumatologist can treat joint inflammation and pain by injecting affected joints with corticosteroid³. They may also decide to treat your symptoms by relieving the pressure in your joint with a needle attached to a syringe. The fluid obtained from your joint can be sent off to a lab where it can be tested to confirm or rule out a different diagnosis.

Prescribing effective medication

Rheumatologists are experienced specialists, so they will be able to prescribe effective medications to manage your symptoms of osteoarthritis. These may include nonsteroidal anti-inflammatory drugs such as naproxen, aspirin, or meloxicam which can reduce joint inflammation and pain.

Other doctors and specialists who treat osteoarthritis

Besides your primary care doctor and rheumatologist, other specialists can help manage your condition. These are:

Orthopedists

Orthopedists are doctors who treat musculoskeletal injuries and diseases, including osteoarthritis. They can provide corticosteroids or hyaluronic acid injections to help manage the condition. They might offer surgical treatment options such as arthroscopy, osteotomy, or joint replacement if needed.

Physical therapist

Your primary care doctor can refer you to a physical therapist who can help to improve your OA symptoms. A physical therapist will assess your joint movement, strength, and flexibility to provide advice about the best exercises and methods of managing your symptoms.

Physical therapists play a critical role in providing preventive care, rehabilitation, and treatment to people with chronic osteoarthritis.

Your primary care doctor might also send you to a doctor who specializes in the area of your body where you have pain or inflammation. Suppose you are experiencing lower back pain — your doctor might recommend seeing a chiropractor⁴.

The lowdown

Osteoarthritis can seriously affect your quality of life. Although the condition has no cure, there are treatments available that could help to ease your symptoms. While your doctor can provide helpful support, they may refer you to a rheumatologist who specializes in conditions like osteoarthritis.

A rheumatologist can offer many treatments and methods of diagnosis that a primary care doctor cannot. They may be a good person to see if your diagnosis is unclear or if your current treatment plan isn’t effective.