Rheumatologist

A rheumatologist is a medical specialist in diseases of the joints, bones, muscles and tendons, and in autoimmune diseases that affect the whole body. Patients sometimes call this doctor a joint specialist or an arthritis doctor; in Israel the word is reumatolog. The rheumatologist sees adults with inflammatory arthritis (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, gout), painful osteoarthritis, lupus, Sjögren's syndrome, scleroderma, vasculitis, osteoporosis, fibromyalgia or unexplained joint pain, especially when joints swell, feel warm or are stiff in the morning. The visit begins with questions about how the pain behaves (time of day, morning stiffness, which joints, associated symptoms such as fever, rash, dry eyes or mouth), then an examination of every joint, the spine and the skin. The arthritis specialist then relies on blood tests (inflammation markers, autoantibodies), X-rays, joint ultrasound often done in the clinic, and sometimes MRI or joint aspiration. Treatment is often long-term and is monitored at regular visits.

• ✓One or more joints that have been swollen, warm and painful for more than two weeks, especially hands, wrists or feet.
• ✓Morning joint stiffness that lasts more than 30 minutes and eases with movement.
• ✓Low back pain that wakes you at night, improves with activity and started before age 45 (possible spondyloarthritis).
• ✓A recurrent gout attack, or high uric acid with painful joints.
• ✓Joint pain together with a rash, dry eyes and mouth, Raynaud's phenomenon or unusual fatigue.
• ✓Psoriasis with pain in the joints or tendons.
• ✓Osteoporosis with a fracture, or a very low bone density in a young person.
• ✓Widespread pain, unrefreshing sleep and chronic fatigue suggesting fibromyalgia, once an inflammatory cause has been ruled out.

In Israel, rheumatology (ראומטולוגיה) is a second-tier specialty: the title specialist in rheumatology (מומחה בראומטולוגיה) is earned after a complete specialty in internal medicine (or paediatrics for paediatric rheumatology), then two to three years of accredited training and the examinations of the Scientific Council of the Israel Medical Association. It is a protected title recorded in the Ministry of Health (משרד הבריאות) public licence register. Before booking, check the register for the licence, the internal medicine specialty and the entry ראומטולוגיה. Rheumatologists are relatively few in Israel and waiting times in the health funds can be long, so some internists or orthopaedic surgeons see patients for joint pain without being rheumatologists; that is fine for simple osteoarthritis but not for a suspected autoimmune disease. For a foreign qualification, the Ministry first recognises the medical degree, then the Scientific Council assesses the specialty case by case; US board certification, a UK CCT, or the French DES in rheumatology (a direct specialty in France, without internal medicine first) are not automatically equivalent to the Israeli pathway. Osteopaths, chiropractors and physiotherapists are not rheumatologists and do not diagnose inflammatory disease.