The physician who is best suited to treat problems of the joints and musculoskeletal system is the Rheumatologist. Rheumatologists are physicians who specialize in treating people who have persistent aches and pains. Initially, a Rheumatologist is trained in Internal Medicine so he is very familiar with the various medical problems that may present with joint complaints. After specializing in Internal Medicine, the Rheumatologist spends two more years sub-specializing in pure rheumatic diseases so that by the time he is able to go out into practice, he is able to recognize the cause of joint complaints, diagnose and treat them appropriately. It is very important for the Rheumatologist to recognize that each patient is his own specific individual and that-despite the fact that a diagnosis of rheumatoid arthritis may be the same from one patient to another, everyone presents in their own fashion and has their own specific and unique needs.
When we prescribe treatment, not only are we utilizing medications which hopefully will reduce the inflammation and control the symptoms, we- are also very concerned with making sure that the patient’s lifestyle, activities of daily living, ability to function at home and at work are also taken into account. The treatment for an 80-year sedentary female would be very different from that of a 30year-old male, despite the fact that they may both have the diagnosis of rheumatoid arthritis.
In addition to medications and an awareness of the patient’s needs, the utilization of a multidisciplinary approach in which the correct exercises, nutrition and understanding by the patient of his/her own limitations are very important for the overall well-being and positive outcome that is desired.
While it is obviously true that there are some very serious diseases that are difficult to treat within the realms of the rheumatic diseases,’ many other conditions do, in fact, respond very well to mild forms of treatment and are very gratifying to treat from a physician’s standpoint.
Today I am using medications for the treatment of these conditions that previously were utilized only in desperate situations or in conditions that were considered far more serious such as malignancies. However, by using very low dosages and using them in a unique fashion, one is able to reduce the side effects significantly and afford the patient tremendous relief from their symptoms. The utilization of medications such as Methotrexate, Imuran and Embrel exemplify this statement.
One cannot emphasize enough that a multidisciplinary approach is needed to successfully treat most patients who are suffering from arthritis. While admittedly many forms of arthritis are not curable, it is certainly my belief and observation that we can help and treat almost any patient who is affected by arthritis in one fashion or another. The statement that “one just has to live with one’s pain” is totally ignorant and in this day and age is outdated.
I think that as a Rheumatologist I run the gamut of two extremes. On the one hand, the frustration and anguish that I feel when I see a patient who comes in with advanced arthritis deformities due to the fact that he has received inadequate or inappropriate treatment is something that never ceases to bother me. I can only hope that in time, as people become more aware of the many things that we can do for their arthritis that this situation will become the lesser of the two extremes. The other side of the coin is that we see many patients who come in with canes or walkers or with severe pain and disabilities who are able to walk out of our offices after a period of time or a course of treatment in much less pain and far more capable of dealing with their daily lives. This gives one a very positive feeling.
In summary, there are many conditions that come under the heading “arthritis”. Most of these conditions are treatable and if someone is bothered by persistent musculoskeletal complaints, seeing a rheumatologist should be mandatory.