Why does one see a rheumatologist?
 

I have seen my primary and neuro. What are the benefits of seeing a rheumatologist?

A rheumatologist can help identify and treat any underlining autoimmmune conditions causing your neuropathy. Of course, they also treat rheumatic disease like rheumatoid arthritis, etc.

This is a good question. So the rheumatologist is the specialist for autoimmune disorders?

this explains:

http://hss.edu/onthemove/ask-the-exp.../#.VSQ6wpN53To

YES...at least most of the more common ones.

Thanks I guess I should find one. Anyone know of a good one in NYC/NJ?

If there is any thought of your neuropathy being autoimmune based, you might ask your neuro for a recommendation for a rheumatologist...this way maybe they will work together better in coordination of care for you.

Yeah good idea. After doing some more research, there's also Immunologists. Too many doctors! :eek:

Theres a difference, Rheumatologists are MDs, dealing with patients with the disease. Immunologist in USA are PHD who are also called DOCTORS/professors. or master degree holders. they are heavily involved in reasearch. while MD are not.

While there are PhDs in immunology and teaching ...many medical doctors are clinical immunologists --often in practice with allergists or have a combined specialty:

http://www.aaaai.org/about-the-aaaai...ed-skills.aspx

Hence there are medical doctors who are certified immunologists and treat patients in a clinical setting.

I've been online for over a decade now, and have noticed more males showing up with problems concerning autoimmune processes. It used to be that females were 9:1 statistically over males for autoimmune diseases.

So I looked up the stats and found this very interesting article.
It has a table showing female to male statistics for US and some countries.

http://www.sciencedirect.com/science...91302214000466

It is a recent article too, so I think many here will find it helpful.
And it does show more males being affected by autoimmune processes today.

Thanks for that link mrsD - I have printed out the article and will read it slowly and carefully - I think that I will learn a lot from it.

Great article MrsD - and very current. I do wonder though if the gender figures in some conditions (ie the predominance of women being affected) may reflect a cultural reluctance by men generally to seek medical help and therefore a recorded diagnosis.

I think its somewhat related to the soceity presentation of men. Appear as hypermasculine, superiority to feminism, and show no "Weakness" this is very prevalent in western society. An example would be a 6ft+ tall muscular male, blonde, blue eyes, with no defects or disease and very well off individual, thats how the world views males. And males in general dont like to go to the doctor,because of this. I see alot of males of this type at my school who are like this, always muscular or acting very masculine, into the whole "fitness,bodybuilder, or powerlifting" fad. It is good to keep a healthy body, but these are designed to be a way to show off thier psyche and masculinity. theres a video titled"mens standard of beauty around the world" on youtube. They describe how masculine, mostly white males are attractive. around the world.
I
skimmed the article, it is implying that some autoimmune diseases are more severe in one sex than the other, and vice versa. Also the ratio is not very clear cut, as they ONly refer to ADULT MALES in this article, so its not really accurate, because it does not include younger males, also the age of the females,pregnancies, also needs to be account. it is also not clear about the ratio, because there are so many autoimmune diseases out there, some like lupus,ms are known to be more predominant in females. This article only goes for highly industrialized countries, like the west, China and india is included. Furthermore, CHINA, india and USA have a much larger population, which includes immigration, so you would expect more autoimmunes to be happening than in the smaller european countries.
This is kind off topic from the OP, but he should only see a rhuemy if a autoimmune, or connective tissue disease is suspected.

The basic premise of why women have more autoimmune issues is because of pregnancy.

Cells from the fetus do escape into the mother's body, and if she has the genetic propensity to react strongly to this, then she may develop an autoimmune disease.

The genetic markers have to be there however to trigger and fuel the autoimmune cascade.

Did you know that scientists have found cells from the fetus in mothers brains long after the pregnancy?

http://www.scientificamerican.com/ar...mothers-brain/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633676/

I think there is a very strong biological component to autoimmune disease in women. We are finding more and more surprises about this topic.

I brought this up because many doctors today, still do not think men get autoimmune disease, and may dismiss a male who is seeking testing and treatment.

So this posting today of mine is to forewarn the males here who might run into a biased physician.

Seems like a visit to the rheumatologist should be part of the testing process for those of us idiopathic cases unless I am missing something.

Correct, Beatle.

Thanks En bloc. I am wondering if at 2.5 years post diagnosis, it would make sense to see one. I never have. I have mentioned it to my PCP but was told "they're just going to want to repeat a bunch of expensive tests to confirm what we already know, that you have peripheral neuropathy and it is incurable".

I've heard the "expensive" remark a few times and I do not understand it. So, because they are costly we should not do them? Why were they developed if they wrote going to be too expensive and therefore not utilized?

Anyway, should I consider seeing a rheumatologist?

They are notorious for repeating and running numerous labs/tests. But they will be looking at the autoimmune side of the problem (to determine if there is an autoimmune issue)...probably not what your neuro or PCP has explored.

I would still check one out, if I were you. If it's autoimmune based, then the signs would still be there 2.5 years later (not like AI disorders disappear).

The 3 rheumatologists I have seen are useless for PN of any cause. They deal with inflammation of joints and tendons and management of medications for inflammation and immunosuppression.

If nerves are involved they will always refer to a neurologist or neurosurgeon.

Fetal cells actually protect the mother and offspring during and after pregnancy specifically the heart, it helps in repairing damaged heart(infarctions) in mice, maybe this is why women are less likely to have certain heart diseases than men. I think autoimmune in women maybe due to thier hormones, specifically.

On an episode of mystery diagnosis, a lady was had a rare autoimmune disease to her own progesterone, which is caused when she gets her period.
@beatle they want those expensive test repeated, because the doctors can make profit off of it, unless your with an HMO.

I have found--
 

--that most rheumatologists are familiar with the anti-nuclear antibody vasculitic/connective disorders, they are not often familiar with a lot of the other autoimmune possibilities, even things like Hashimoto's thyroiditis, and certainly not with a lot of the autoantibodies to components of central and peripheral nerve (many have not heard of Purkinje, GM1, GD1, anti-sulfatide class antibodies, for example). Then again, many neurologists haven't heard of these, either.

I personally find the whole field of autoimmunity fascinating, given that the leading assumption for the cause of my acute-onset body-wide small fiber neuropathy was/is autoimmune molecular mimicry (I've done a LOT of reading on the topic over the years; moreover, my wife works in development for the SLE [Lupus] Foundation, and I get to see a lot of the research papers coming out of there, as well as related ones).

One of the aspects of the gender differences in autoimmune condition occurrence I've become aware of, and that ties in with Mrs. D's hormonal/pregnancy musings, is that the gender imbalance in occurrence is much more pronounced during the childbearing years. For pediatric patients (though they more rarely show autoimmunity) and for the elderly, the gender imbalances are no where near as wide. For lupus, for example, there's about a 9:1 female/male ration before age 50, but after 50 the ratio reduces rapidly until above 65 it's more like 2:1. This pattern also seems to happen in MS (the usually given 3:1 female preponderance also drops with age) and with things like psoriasis and Hashimoto's. One wonders if post menopause the factors that predispose females to autoimmunity become muted and that results in the ratios becoming more even.

Everyone has interesting points about this subject. There are rheumatologists that are well versed in immune mediated neuropathy and there are those that aren't.

I guess I have been spoiled, as my treating physician at Johns Hopkins is BOTH a rheumatologist and neurologist. He specializes in the neurologic manifestations of rheumatic and autoimmune disease...with special interest in neuropathy associated with Sjogren's. He is the ONLY doctor in the entire nation to be both specialties.

He certainly would be helpful for several members here with documented immune mediated neuropathy (he only sees patients already documented with the combination). His name is Dr. Julius Birnbaum (located at Johns Hopkins), and although a detailed and time consuming process to get in to see him, it's well worth the wait.

Our own MG forum demonstrates these gender bias changes.

It used to be that males begin to develop myasthenia gravis at around age 50 or later. Now we are seeing young males showing up on that forum, some with severe MG.

I have been thinking that it is the enormous push for vaccines that are triggering those who have the genetic markers for possible autoimmune disease.

Like Sorgren's... MG has a negative antibody testing group with severe symptoms. That fits in with the theory that not all the antibodies that cause these and other syndromes have not been identified (found) yet. Glenn often mentions this aspect to the antibody testing explanations that he generously provides here on PN.

dont forget that autoimmunity is also not gender related, its also environmental. I posted in another thread, where the lack of exposure to microbes in early childhood will contribute to the autoimmune factor, this is becoming an increasing part of research. The more cleaner we are the more likely we will suffer cancers and autoimmune. In industrialized, and lising countries, autoimmune, allergies, cancers, are the predominant diseases, including inflammatory. At a young age, our immune system needs to develop by being exposed to non-infectious and infectious microbe to properly develop.
Something like chickenpox,measles mumps are mild illnesses in children, while teens and adults who get these for the first time can be much more severe.

Oh boy. It seems like Rheumatology is more geared towards joint/muscle issues. Why do I have a feeling once I see one, they will just refer me to a Neurologist?

How about a pathologist? immunologist? Just looking for someone who can do lots of lab testing for possible causes.

What exactly are you looking for in "labs"? If you are looking for autoimmune conditions, then a rheumatologist IS the doctor you want.

Most immunologists focus more on allergies and immune deficiencies. There are some that work with autoimmune disease, but you need to search them out.

A rheumatologist will run a ton of labs...they are notorious for this and extended consults/exams as well. My last trip to the rheumatologist, he took 13 tubes of blood (and some were to run more then one test from same tube).

Wow! 13 tubes...I've never had anywhere near that much blood taken from me lol


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