Rheumatology is the medical specialty dedicated to the diagnosis, monitoring and treatment of pain and disease of the bones, spine, muscles and joints. (locomotor device) :

• the bones: bone pathologies;
• the spine: spinal pathologies (of the spine);
• the joints: arthropathies and periarticular disease.

Note that rheumatic diseases, in particular systemic inflammatory rheumatism, can also affect other organs. These are most often autoimmune diseases, which start with damage to the joints and then affect the skin, heart, kidneys, lungs, etc. Treatment in rheumatology is therefore often coupled with treatment in internal medicine.

Rheumatology is for people with pain, disabilities, functional discomfort in the bones, joints or muscles.

The rheumatologist (or rheumatologist) is thus involved in the treatment of many diseases:

• Osteoarthritis ;
• osteoporosis ;
• rheumatoid arthritis ;
• spondylatropathies (ankylosing spondylitis among others);
• autoimmune diseases with involvement of the joints, especially lupus, Gougerot-Sjögren syndrome, vasculitis, systemic scleroderma…;
• rheumatic diseases of the child;
• arthritis of infectious or metabolic origin such as gout or chondrocalcinosis.

The rheumatologist also takes care of:

• pain related to the spine (” sciatica » herniated discs, neck pain, etc.);
• back pain (lumbago);
• pain related to tendons or muscles (tendonitis, myositis);
• ligament hyperlaxity;
• or diffuse pain present in certain diseases such as fibromyalgia.

Rheumatic diseases are likely to affect everyone, but there are some recognized risk factors, including:

• the female sex;
• age;
• genetic factors;
• practicing a sport or a job involving intense and repetitive movements or repeated trauma;
• overweight or obesity.

To arrive at a diagnosis and identify the origin of joint or bone disorders, the rheumatologist:

• questions his patient;
• performs a rigorous clinical examination;
• may have recourse to additional examinations (CT scan, MRI, etc.) or to various biological analyzes which make it possible to orient the diagnosis, in particular for autoimmune diseases.

Depending on the course of the disease and the treatment, the rheumatologist may have to perform certain medical procedures, in particular:

• joint punctures;
• joint infiltrations and washings;
• ultrasound-guided procedures.

He can also perform tests such as bone densitometry to assess bone density, or an electromyogram to study the functioning of one or more muscles.

The consultation with a rheumatologist does not involve any particular risks for the patient, even if certain imaging examinations can cause allergic reactions (use of contrast agents).

Rheumatologist training in France

To become a rheumatologist, the student must obtain a diploma of specialized studies (DES) in rheumatology:

• he must first follow, after his baccalaureate, a common first year in health studies. Note that an average of less than 20% of students manages to cross this milestone.
• the 4th, 5th and 6th years at the Faculty of Medicine constitute the clerkship
• at the end of the 6th year, students take the national classifying tests to enter the boarding school. Depending on their classification, they will be able to choose their specialty and their place of practice. The rheumatology internship lasts 4 years (8 semesters).

The training of a rheumatologist in Quebec

After college studies, the student must pursue a doctorate in medicine. This first stage lasts 1 or 4 years:

• a preparatory year for medicine for students admitted with a college or university training deemed insufficient in basic biological sciences;
• two years of pre-apprenticeship;
• two years of clerkship.

Then, the student will have to specialize by following 3 years of internal medicine then a residency in rheumatology of 2 years.

Before going to the appointment with a rheumatologist, it is important to take any x-rays, scans, IRM or biology examinations already carried out.

It is important to note the characteristics of the pain (mostly nocturnal, morning, relief or not after exertion, etc.) and to report all the symptoms, even those that do not seem to you to be related to joint pain.

To find a rheumatologist:

• in Quebec, you can consult the website of the association of rheumatologists of Quebec³ and the Canadian society of rheumatologyâ ?? ´, which offer a directory of their members
• in France, via the website of the Ordre des médecinsâ ?? µ or the French Society of Rheumatology6

The consultation with the rheumatologist is covered by the Health Insurance (France) or the Régie de l’assurance maladie du Québec.