What is a rheumatologist

The members of the Professional Association of German Rheumatologists (BDRh) include specialists working in clinics or practices with a focus or additional training in rheumatology who have trained as internists, orthopedists or pediatricians as internal, orthopedic and pediatric rheumatologists.

Specialists in internal medicine and rheumatology specialize in the diagnosis and non-surgical treatment of patients with autoimmune-related inflammatory rheumatic diseases, e.g. rheumatoid arthritis (rheumatoid arthritis), psoriatic arthritis, ankylosing spondylitis (ankylosing spondylitis) and the diagnosis and treatment of various collagenoses, vasculitides and myositides, reactive arthritis, hormonal (endocrine) and metabolic (metabolic) joint diseases, chronic bone diseases (osteopathies), or chronic "soft tissue rheumatic" diseases (e.g. fibromyalgia).

Orthopedists and trauma surgeons with the additional advanced training in rheumatology acquire knowledge, experience and skills in the prevention, detection and surgical treatment of joint, spine and soft tissue manifestations in inflammatory rheumatic diseases and their epidemiology, as well as in the indication and implementation of rheumatic orthopedic operations the soft tissues, the spine and the joints, as well as in physical therapy measures, physiotherapy and occupational therapy, positioning, orthoses, splint and apparatus technology as well as joint injections. The focus here is on advice and the implementation of surgical therapy. Physical therapy (physiotherapy and occupational therapy), injection treatment and drug and interventional pain therapy, as well as orthopedic care are other focal points of the activity.

Pediatricians (specialists in pediatric and adolescent medicine) with additional training in rheumatology have specialized in the special conditions of diagnosis and treatment of children with autoimmune inflammatory rheumatic diseases, e.g. juvenile chronic polyarthritis and its various forms, juvenile spondyloarthritis, the Diagnosis and treatment of childhood forms of the various types of collagenosis, vasculitis and myositis, as well as reactive arthritis in childhood.

Further training to become a specialist in internal medicine with a focus on rheumatology is much more complex. It is important to acquire knowledge, experience and skills in the common content for the specialist and specialist competencies contained in the area. This includes the detection and conservative treatment of rheumatic diseases including inflammatory rheumatic systemic diseases such as collagenoses, vasculitides, inflammatory muscle diseases and osteopathies, the prescription and functional testing of orthoses and aids in rheumatic diseases, the indication of radiological examinations and classification of the findings in the The clinical picture, the indication, methodology, implementation and classification of the laboratory tests of immunological parameters in the clinical picture, the interdisciplinary indication of surgical, radiotherapy and nuclear medicine treatment methods and basic intensive care.

Important examination methods of rheumatologists

The focus of internal rheumatology is on the comprehensive differential diagnosis and therapy of diseases of the rheumatic type. The following methods in particular are used for differential diagnosis, based on the medical history (anamnesis) and clinical findings:

  • Ultrasound and magnetic resonance imaging of the joints or the spine, x-rays and, less often, other imaging procedures (e.g. computed tomography, bone scintigraphy)
  • rheumatological-immunological laboratory diagnostics (special rheumatological blood tests)
  • joint sonography (joint puncture and subsequent microscopic examination of the synovial fluid)

Examination and treatment methods for orthopedists with additional training in rheumatology include rheumatic orthopedic operations on the soft tissues, the spine and joints, sonographies of the musculoskeletal system including arthroscopic ultrasound, as well as local and intra-articular punctures and injection procedures.

Central treatment methods of rheumatologists

The treatment of rheumatic diseases is usually complex. Because the course of a disease and the response to therapy can be extremely different from patient to patient, even with the same diagnosis. Therefore, the treatment plan must always be individually tailored to the patient and can - depending on the individual disease - include the following:

  • various forms of drug treatment (especially disease-modifying long-term treatment)
  • Punctures and joint therapy (intra-articular, i.e. inside the joint)
  • Physical therapy (especially physiotherapy)
  • Occupational therapy (joint protection treatment)
  • Provision of orthoses (aids for joint protection)
  • Patient training, psychosocial care, initiation of rehabilitation measures
  • Indication for treatment by the orthopedic rheumatologist (rheumatism surgery)

Interdisciplinary cooperation in therapy

The outpatient and inpatient care of patients with rheumatic diseases is carried out in close cooperation with general practitioners and members of medical assistant professions, primarily physiotherapists and occupational therapists. In the event of accompanying illnesses, the therapy is carried out in close cooperation with, for example, specialists in dermatology, neurology, ophthalmology, and with internal specialists specializing in angiology, gastroenterology, cardiology and pulmonology.

Further training to become a rheumatologist

There are three different advanced training courses in rheumatology: the specialist in internal medicine with a focus on rheumatology, the additional training in orthopedic rheumatology for the specialist in orthopedics and trauma surgery and the additional training in pediatric rheumatology for the specialist in pediatric and adolescent medicine. The prospective specialist in internal medicine with a focus on rheumatology completes a 6-year advanced training course after completing his medical degree. Defined examination and treatment procedures are listed in the further training regulations. At the end of the training period, the acquisition of the necessary knowledge, experience and skills, which the focus on rheumatology includes, is checked in an oral exam.