Comprehensive Care for Back Pain: The Role of a Rheumatologist

Back pain is one of the most common reasons for seeking health care. Individuals dealing with back pain but don’t know the cause may have some inflammatory joint disease or autoimmune condition. Can seeing a rheumatologist help?

Rheumatologist

Depending on what’s causing the back pain, individuals may need to see their primary doctor for a referral. Individuals are recommended to see a rheumatologist if they have back pain that doesn’t come from an injury that doesn’t go away after a few weeks, pain that comes back after treatment, or symptoms that suggest a rheumatic condition. Rheumatologists treat severe or persistent back pain and are experts in autoimmune diseases, including lupus, Sjogren’s syndrome, rheumatoid arthritis, ankylosing spondylitis, axial spondylitis, Psoriatic arthritis, and other forms of inflammatory or autoimmune arthritis.

What Do They Do?

A rheumatologist is an internist or pediatrician who has completed special training in treating conditions that are:

• Inflammatory
• Autoimmune
• Related to painful joint disease

The doctors diagnose, treat, and manage these conditions long-term. Depending on diagnosis and care needs, they may also lead or be part of a team that includes other healthcare providers.

Symptoms

When muscles ache, pain presents, or joints hurt, and especially if there are signs of inflammation that don’t go away, seeing a healthcare provider is recommended. Symptoms of inflammation include:

• Redness
• Swelling
• Pain
• Stiffness
• Loss of joint function

Usually, to see a rheumatologist, individuals need a referral from their primary care provider and may be referred when:

• There is no evidence of a back injury.
• At-home therapies like heat application, prescription medications, or physical therapy are unsuccessful.
• There is uncertainty about what’s causing the back pain, but I suspect it’s rheumatological.
• Blood tests for inflammatory markers or certain antibodies yield abnormal results.
• There is a diagnosis of a rheumatic condition and recommend a specialist to manage it.
• There is a family history of a rheumatic or autoimmune condition that may cause back pain.
• There is a chronic pain condition that later develops back pain (Hospital for Special Surgery, 2023)

Individuals may also be referred to a rheumatologist if their back pain is accompanied by:

• Pain in multiple parts of the body
• Red, swollen joints
• Fatigue
• Skin rashes
• Fever
• Pain and inflammation that come and go (Yale School of Medicine, 2021)
• Fingers that turn blue or ache when exposed to the cold
• Unexplained weight changes (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)
• Dry eyes and mouth

Some types of arthritis can cause permanent, progressive joint damage.

Conditions

Conditions that can affect the spine and cause back pain and are treated by a rheumatologist include: (Johns Hopkins Medicine, 2024)

Rheumatoid arthritis (RA)

• This often starts in smaller joints of the hands and feet and later moves to the neck and/or back.
• It can also affect different body organs and have systemic symptoms.

Ankylosing Spondylitis (AS)

• Primarily a disease of the spine, it may also impact the shoulders, hips, knees, and ankles.
• Systemic symptoms, including fever and fatigue, can manifest.

Axial Spondylitis

• This primarily affects the spine, chest, and pelvis.
• It may also cause problems with the connective tissue, eyes, bowel, and skin.

Psoriatic Arthritis (PsA)

• Pain in the lower back is common, especially in severe cases.
• It can affect other joints and cause psoriasis.

Reactive Arthritis

• This is a reaction to infection.
• It is more common in the limbs, hands, and feet joints but can involve the spine.

Enteropathic Arthritis

• This mainly affects the spine but can include other joints.
• It is associated with inflammatory bowel disease.

Autoimmune diseases that don’t specifically target the spine but can also cause back pain include:

• Lupus
• Sjögren’s syndrome
• Hashimoto’s thyroiditis

Finding a Doctor

Individuals may be fine with their primary healthcare provider’s choice regarding which rheumatologist to see. However, they may want to research other options to ensure the right rheumatologist is chosen. Things to look at include:

• Search online medical directories.
• Visit the websites of the doctors being considered to learn more about their training, approach, and specialties.
• Check online reviews.
• Check on health insurance coverage.
• Ask members of the healthcare team, friends, and family for recommendations.
• Contact rheumatologists’ offices to see if they are accepting new patients.
• Once decided, pass along the information to the primary care doctor so they can make the referral.

Preparing For The Initial Visit

Before seeing a new rheumatologist, take a few minutes to prepare so you can make the most of the appointment. Individuals will want to have:

• A list of back-related symptoms, including frequency and severity.
• A list of what makes symptoms better or worse.
• A copy of recent test results and records from other doctors.
• Individuals can ask their provider/s to send their medical information to the rheumatologist’s office in advance.
• A list of treatments that have been tried and how well they worked.
• A list of all medications, over-the-counter and prescription, supplements, and herbal products taken.
• A list of medication allergies.
• Complete medical history and family history of potentially related diseases.
• A list of any questions regarding conditions, treatment, etc.
• If possible, fill out any paperwork for the new office beforehand to save time on the appointment day.

Injury Medical Chiropractic and Functional Medicine Clinic

Talking with a healthcare provider is important. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.

Quick Patient Initiation Process

References

Hospital for Special Surgery. (2023). What Is a Rheumatologist and What Conditions Do They Treat? www.hss.edu/conditions_what-is-a-rheumatologist.asp#when

Yale University School of Medicine. Dee, J. E. (2021). 5 reasons why a patient should see a rheumatologist. medicine.yale.edu/news-article/5-reasons-to-see-a-rheumatologist/

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Autoimmune diseases. Retrieved from www.niams.nih.gov/health-topics/autoimmune-diseases

Johns Hopkins Medicine. (2024). Spinal arthritis (arthritis in the back or neck). www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-arthritis