Most people with RA are treated by either a medical internist or a rheumatologist. Which one a patient chooses as his or her treating physician depends on many factors:
- The physician's training and experience in caring for patients with RA
- His or her board certification
- The proximity of the physician's office to your home
- Whether the physician participates in your insurance plan
- The doctor's reputation in the community
- Your ability to build a trusting relationship with the physician
- The doctor's ability to speak your native language or understand your culture and customs
While many of these issues do not necessarily bear directly on a doctor's clinical abilities, patients will often choose a doctor based on what is most important to them. Medical internists are specialists. They have training and experience in caring for common rheumatic diseases such as RA, and they are qualified to provide care for typical cases of RA. Nevertheless, the amount of training and experience that an internist has is less than that of a rheumatologist.
Rheumatic disease
Any one of more than 100 disorders that cause inflammation in connective tissues.
Rheumatologists are subspecialists. Their practice is limited to people who suffer from acute and chronic musculoskeletal diseases, one of the most common of which is RA. Treating these musculoskeletal diseases often requires complicated therapeutic regimens. These regimens typically require the use of multiple medications, such as nonsteroidal anti-inflammatory medications, corticosteroids, immunosuppressive therapy, and the newer biological therapies. These treatments have significant risks, so their use requires close monitoring. Rheumatologists regularly collaborate with providers of physical and occupational therapy, orthopedic surgeons, and vocational rehabilitation specialists, all in an effort to make sure their patients receive the best care and have the best chance at recovery.
Immunosuppressive therapy (immunosuppressant)
An agent capable of suppressing the immune response. Such medications increase a person's risk for infection and malignancy.
A consultation with a rheumatologist may be necessary in any of the following circumstances:
- After careful examination and appropriate testing, your primary care physician is unsure of the diagnosis.
- Your arthritis is unusually severe or disabling.
- Your arthritis extends beyond your joints and affects other parts of your body such as your skin, eyes, lungs, or heart.
- Your arthritis is complicated with another disease such as gout, heart disease, or kidney disease.
- Your RA symptoms are getting worse despite treatment.
- Your arthritis requires treatments that your primary care physician is unfamiliar with or uncomfortable administering, such as chemotherapeutic, immunosuppressive, or biological agents.
Unfortunately, many types of rheumatic diseases may not be readily identified in the early stages of the illness. Whether your condition is simple or complex, prompt diagnosis and early treatment are important both for your comfort and for your long-term well-being. In some cases, when RA is untreated or inadequately treated for a long time, injuries to the joints can occur that result in permanent disability or necessitate joint replacement.