What Does a Rheumatologist Do? A Whittier Rheumatologist Explains
Dr. Su reviewing symptoms with a patient at our Whittier office.
What does a rheumatologist do? In one sentence: a rheumatologist is a medical doctor who diagnoses and treats arthritis, autoimmune diseases, and other conditions of the joints, muscles, bones, and immune system, using medication rather than surgery. If your primary care doctor just sent you to one, that referral usually means something in your exam or your labs deserves a specialist’s eye. A referral does not necessarily mean something serious. Often it is to rule a condition out. Here is what we do, what we do not do, and what your first visit at our Whittier office actually looks like.
What is rheumatology?
Rheumatology is the branch of internal medicine that focuses on rheumatic diseases: conditions that cause pain, swelling, stiffness, or damage in the joints, tendons, ligaments, muscles, and bones, and sometimes in the blood vessels and internal organs. Many of them are autoimmune, which means the immune system is attacking the body’s own tissue. The American College of Rheumatology counts more than 100 of these conditions, ranging from common ones like osteoarthritis and gout to rarer ones like scleroderma and vasculitis.
A rheumatologist trains for that whole spectrum. After medical school, we complete a residency in internal medicine and then a rheumatology fellowship, which typically adds another two to three years focused entirely on these diseases. I did my medical training at UCLA and my rheumatology fellowship at the Keck School of Medicine of USC, and every physician at Amicus Arthritis is board certified in the specialty.
The short version: if your problem lives in the joints or the immune system and it is not something a surgeon needs to fix, it is probably a rheumatology problem.
What does a rheumatologist do day to day?
Most of our work is detective work. Joint pain has dozens of possible causes, and many rheumatic diseases look alike in the early months. We take a careful history, examine every joint (not just the one that hurts), and decide which blood tests and imaging will actually answer the question. Then we build a treatment plan and adjust it over time, because most of these conditions are managed rather than cured.
We also do procedures. In our Whittier office that includes joint injections, drawing fluid from a swollen joint to look for crystals or infection, bone density (DEXA) scans, and supervising IV infusions of biologic medications in our in-office infusion center. What we do not do is operate. A rheumatologist is a physician, not a surgeon.
Conditions a rheumatologist treats
The list is long. These are the conditions we see most often at Amicus:
Rheumatoid arthritis: an autoimmune disease that attacks the joint lining. Our RA care.
Gout: sudden, intensely painful joint inflammation caused by uric acid crystals. Our gout care.
Osteoporosis and osteopenia: bone loss that raises fracture risk, measured with a DEXA scan. Our osteoporosis care.
Lupus and other autoimmune diseases: conditions that can involve joints, skin, kidneys, and blood. Our lupus care.
Psoriatic arthritis: inflammatory arthritis linked to psoriasis.
Ankylosing spondylitis, now often called axial spondyloarthritis: inflammatory arthritis centered on the spine and pelvis.
Sjögren’s syndrome, scleroderma, and vasculitis: less common autoimmune diseases that need long-term specialist monitoring.
Myositis: inflammatory muscle disease causing weakness, often in the shoulders and hips.
Polymyalgia rheumatica: sudden shoulder and hip stiffness, usually in adults over 50, that responds quickly to the right treatment. If you have a new headache, jaw pain when chewing, scalp tenderness, or vision changes, seek care the same day.
Fibromyalgia: a real condition with its own diagnostic criteria. Rheumatologists often help confirm it and check that nothing inflammatory is also going on. Our fibromyalgia care.
Osteoarthritis: when it is widespread or when injections and non-surgical care are the right path.
If a condition can show up in the joints and also in the skin, eyes, kidneys, lungs, or blood work, a rheumatologist is usually the doctor coordinating the care, working alongside your primary care physician and any other specialists you already see.
What a rheumatologist does not treat
Knowing this up front can save you a visit. We do not repair torn ligaments, replace joints, or fix fractures; that is orthopedic surgery. We do not treat a single sprained ankle or a bunion; that is usually your primary care doctor or a podiatrist. We do not manage back pain that comes from a disc or a pinched nerve unless an inflammatory disease is suspected. And while we treat the joint damage that psoriasis or Crohn’s disease can cause, a dermatologist or gastroenterologist still manages the skin or the gut.
If you are not sure which doctor you need, our post on rheumatologist vs. orthopedist walks through the difference in more detail.
Rheumatologist, orthopedist, or primary care: which one do you need?
A useful rule: if the pain started with an injury or a specific movement, and one joint is involved, start with orthopedics or your primary care doctor. If several joints hurt, if joints are swollen or warm without an injury, if stiffness is worst in the morning and lasts more than 30 minutes, and often an hour or more in rheumatoid arthritis, if you have a rash, dry eyes and mouth, or unexplained fatigue along with the joint pain, or if your blood work came back with an abnormal ANA, rheumatoid factor, uric acid, or inflammation marker along with symptoms, you belong with a rheumatologist. One exception: a single hot, swollen joint, especially with a fever, should be seen the same day, because it could be gout or an infection.
Your primary care physician is the right first stop for almost everything, and in most California HMO plans the referral has to come from them anyway. Our page on 7 signs you should see a rheumatologist covers the specific symptoms that should prompt that conversation.
30 minutes. Morning stiffness that lasts longer than about 30 minutes, and often an hour or more in rheumatoid arthritis, is one of the classic clues that separates inflammatory arthritis from ordinary wear and tear. It is one of the first things we ask about.
Why your doctor referred you to a rheumatologist
The most common reasons we see on referral notes: joint pain and swelling that has not improved with rest or anti-inflammatories, a positive ANA or rheumatoid factor on routine labs, elevated inflammation markers (CRP or ESR), a high uric acid level along with symptoms, or a suspected gout attack, a bone density scan showing osteoporosis or a fracture that happened too easily, and symptoms that suggest lupus or another autoimmune disease.
An abnormal lab result on its own does not mean you have a disease. A low-level positive ANA, for example, shows up in a significant share of healthy people, especially women and older adults. Part of what a rheumatologist does is put that number in context with your exam and history, and tell you plainly whether it matters.
Referred to a rheumatologist and not sure what comes next? Our Whittier office offers new patient appointments within the same week in most cases. Call and our staff will tell you up front whether your plan needs a referral. Call (562) 758-6600 or request an appointment online.
What happens at your first rheumatology visit in Whittier
Plan on a longer visit than a typical checkup. We start with your story: when the symptoms began, which joints, what makes them better or worse, and what else has been going on in your body, from rashes to digestion to sleep. Bring any recent lab results, imaging reports, and a list of every medication and supplement you take. Wear loose clothing so your joints can be examined easily. If a rash or swelling comes and goes, bring photos of it. Bring your insurance card, and your referral if your plan needs one. You can download our new patient forms ahead of time to shorten the check-in.
Then comes the examination. We look at and move every joint, check your skin, eyes, and mouth, and listen to your heart and lungs, because rheumatic diseases rarely stay in one place. By the end of the visit you will usually leave with a working diagnosis or a short list of possibilities, a set of tests to confirm it, and a plan for what happens at the next visit.
Because our bone density scanner, lab draw, joint injection room, and infusion suite are all inside our Whittier office, much of that testing can happen the same day or the same week instead of being scattered across town.
Tests a rheumatologist may order
Blood work is the workhorse: inflammation markers, autoantibodies such as ANA, rheumatoid factor and anti-CCP, uric acid, kidney and liver function, blood counts, and urine tests, which matter for checking the kidneys in lupus and vasculitis. Imaging depends on the question. X-rays show joint damage, ultrasound can show inflammation and crystal deposits, MRI can show inflammation in the spine and in joints that X-rays miss, and a DEXA scan measures bone density. When a joint is swollen and the cause is unclear, we may draw a small sample of joint fluid and examine it under the microscope, which is the most definitive way to diagnose gout, and, with a cell count and culture on that fluid, to check for infection.
We order tests to answer a specific question, not to run every panel available. If a test will not change what we do, we will tell you that too.
Treatments a rheumatologist manages
Rheumatology has changed enormously over the past two decades. For inflammatory arthritis we use disease-modifying drugs like methotrexate, and when those are not enough, biologic and targeted medications that block specific parts of the immune system. Steroids such as prednisone are common for calming a flare quickly, and we aim for the lowest dose for the shortest time because of their side effects. For lupus we often use hydroxychloroquine, which needs a yearly eye exam. Most of these medicines need routine blood tests while you are taking them. Some of those are pills, some are injections you give yourself, and some are IV infusions we give in our office. For gout we calm the flare, then lower uric acid with daily medication so the attacks become rare or stop. For osteoporosis we use medications that slow bone loss or build new bone, along with fall prevention and nutrition.
Joint injections with steroid or other agents can settle a single stubborn joint. And because our practice runs clinical trials, patients in Whittier sometimes have access to investigational treatments before they are widely available. Clinical trials have eligibility requirements and are not right for everyone. We will talk through the benefits and the risks if one fits your situation.
Referrals, insurance, and Medicare in California
Whether you need a referral depends on your plan. Most PPO plans let you book directly. HMO plans and medical groups (IPAs) in Los Angeles County usually require a referral from your primary care physician, and our staff will tell you before your visit if that applies to you. We accept Medicare and most PPO, HMO, and IPA plans. We also accept Medi-Cal. Coverage for services such as bone density scans and in-office infusion therapy depends on your plan, and we verify your benefits before treatment starts.
If cost is a concern, say so at the first call. Knowing your coverage early lets us choose tests and treatments that fit your plan.
Finding a rheumatologist near you in the San Gabriel Valley and Southeast LA
Amicus Arthritis & Osteoporosis Center is an independent rheumatology practice at 12456 Washington Blvd in Whittier, a short drive from El Monte, Temple City, Alhambra, Rowland Heights, Diamond Bar, Montebello, Pico Rivera, Downey, Santa Fe Springs, and Norwalk. Our rheumatologists see patients in English, and several also in Spanish, Mandarin, or Farsi, and our staff can help you in Spanish from the first phone call. Directions and parking details are here, and our Spanish-language page is here.
If you have been living with joint pain, swelling, or a lab result nobody has explained, that is exactly what a rheumatologist is for. Call us, and let us find out what is going on.
Frequently asked questions
How long does it take to become a rheumatologist?
After four years of medical school, a rheumatologist completes a three-year internal medicine residency and then a rheumatology fellowship, which typically lasts two to three years. Board certification in rheumatology comes after that. All told, most rheumatologists finish training nine or more years after starting medical school.
Do I need a referral to see a rheumatologist in California?
It depends on your insurance. Most PPO plans allow you to book directly. HMO and IPA plans usually require a referral from your primary care physician. Call our Whittier office and our staff will check your plan and tell you before you come in.
Is a rheumatologist a surgeon?
No. A rheumatologist is a physician trained in internal medicine who treats joint and autoimmune conditions with medication, injections, infusions, and monitoring. Joint replacement and other surgery is done by an orthopedic surgeon. The two specialties often work together.
What is the most common condition a rheumatologist treats?
In our Whittier practice the most common diagnoses are rheumatoid arthritis, gout, osteoporosis, osteoarthritis, and lupus. Across the United States, osteoarthritis is the most common form of arthritis, though many cases are managed by primary care doctors rather than by rheumatology. Fibromyalgia, psoriatic arthritis, and polymyalgia rheumatica are also frequent.
Does a rheumatologist treat fibromyalgia?
Yes. Rheumatologists are often the specialists who diagnose fibromyalgia, partly because its symptoms can overlap with inflammatory arthritis and it is important to rule those out first. Treatment starts with regular, gradual exercise, which has the strongest evidence behind it, alongside attention to sleep, stress management, cognitive behavioral therapy, and medication where it helps. Once the diagnosis is confirmed, long-term care is often managed together with your primary care physician.
Call (562) 758-6600 to schedule with a rheumatologist in Whittier.
This article is for general educational purposes and does not replace personalized medical advice. If you have a fever with a hot, swollen joint, or symptoms that are getting worse quickly, seek urgent care.