What Doctors Treat Lupus and Fibromyalgia ?

What kind of doctor treats lupus? It’s a common question for those who may have or have been diagnosed with systemic lupus erythematosus (SLE) or another form of lupus. Since most people with lupus end up seeing a number of different specialists, it can be helpful to explore the types of specialists who may be involved in your comprehensive medical care.

Rheumatologists (Autoimmune Disease Specialists)

Typically, lupus is treated by rheumatologists. Rheumatologists are internists or pediatricians (or both) that specialize in the diagnosis and treatment of arthritis and other diseases of the joints, muscles, and bones, as well as certain autoimmune diseases, including lupus and rheumatoid arthritis.

In the United States, rheumatologists for adults are first board-certified in internal medicine, a program that requires at least three years of medical residency after medical school. This is followed by a fellowship for two years in rheumatology after which they may become board certified in rheumatology.¹

Your Healthcare Team

Most of the time you will have a team of physicians and therapists who will help you control the symptoms of your disease as well as its limitations.

All of these specialists may play specific roles in managing your disease, but it’s often your rheumatologist who acts the quarterback, so to speak—the one who coordinates the care given by your entire healthcare team, making sure that all of your concerns are being addressed and that there are no interactions between the medications and other treatments provided.

Your rheumatologist is usually the person you will call if you have any questions or concerns, as well as the person who will help to connect you with other specialists who can help you care for specific aspects of your disease. Studies have found that people who have good patient-physician communication not only feel more empowered in their care but may have better outcomes as well.

Knowing this, it’s very important to find a rheumatologist you feel comfortable talking to and who you can communicate well with.²

How Rheumatologists Diagnose and Evaluate Lupus

If your primary care doctor suspects you have lupus, you will be referred to a rheumatologist. The rheumatologist will take a thorough history of your symptoms and do a physical exam looking for the signs and symptoms of lupus. They will also run blood tests to check for indications of lupus.

The first blood test a rheumatologist will conduct to check for lupus is called an antinuclear antibody (ANA) test. This test looks for autoantibodies to nuclei in cells. Autoantibodies are antibodies similar to those you would develop after a viral infection or in response to a vaccine, but with lupus, these antibodies are instead directed at some of your own cells. Almost all people with lupus will have a positive ANA test.

That does not necessarily mean you have lupus, however. Some people who have a positive ANA test have scleroderma, rheumatoid arthritis, mixed connective tissue disease, or a different connective tissue disease. And up to 10{f3a6a30fe8ec83c88e3a096004ddf2d5481b76e701b36185325949387956c891} of people with no rheumatological disease will have a positive ANA.

The road to diagnosis can be slow and frustrating, as there are many different diseases with considerable overlap with lupus. It’s important to remain dedicated to the process, however, as making an accurate diagnosis is essential to finding the best treatments.

After a positive ANA test, the rheumatologist will probably run more blood tests to look for other antibodies that can help pinpoint whether or not you have lupus or another condition. The common follow-up to a positive ANA test is the ANA panel, which looks for these antibodies:

• Anti-double-stranded DNA (anti-dsDNA)
• Anti-Smith (anti-Sm)
• Anti-U1RNP
• Anti-Ro/SSA
• Anti-La/SSB

Some labs will also test for anti-nucleoprotein, anti-centromere, anti-histone, or anti-Scl-70.

Rheumatologists also use other tools—such as medical history, a physical exam and skin, and kidney biopsies—to make a lupus diagnosis.

Once lupus is diagnosed, your rheumatologist will work with you to come up with a treatment plan (including lupus medications) that makes sense for you. Rheumatologists help patients prevent and treat lupus flares and reduce organ damage and other problems.

Your treatment may need to change many times over the course of your life, depending on the state of your disease and other factors. Your rheumatologist can help you navigate these changes.³

 How Lupus Is Diagnosed

Other Doctors Who Treat Lupus Patients

Lupus can affect nearly any organ or organ system in your body, and you may need to have a specialist in that particular area. In addition, you may need to have specialists who can help you cope with the limitations or emotional impacts of your disease.

Some specialists who may be part of your team include:

Medical Specialists

These may include:

• Cardiologist: For heart issues, such as lupus myocarditis and lupus pericarditis
• Pulmonologist: For lung issues, such as pleurisy due to lupus and other lung conditions
• Endocrinologist: For issues relating to your thyroid, adrenal function, or other endocrine issues
• Nephrologist: For issues relating to your kidneys and kidney function, such as lupus nephritis
• Gastroenterologist: For digestive tract issues
• Hematologist: For issues relating to your blood count
• Clinical immunologist, a doctor who address the underlying process of your disease

Skin Specialists

Rashes are very common with lupus, and many people have a dermatologist (a skin specialist) as part of their team. Lupus may also cause photosensitivity, which your dermatologist can help manage.

You may be able to see a dermatologist who specializes in the skin manifestations of lupus at some of the larger medical centers.

Neurological Specialists

A neurologist may be part of your team in order to address the nervous system manifestations of lupus.

Rehabilitation Specialists

Depending on your specific symptoms, you may see a physical therapist to reduce joint pain and stiffness or an occupational therapist.

Physiatrists are physicians who specialize in physical medicine and rehabilitation and may be sought out to help coordinate a comprehensive rehabilitation plan.

Rehabilitation medicine can make a significant difference in quality of life for people living with chronic diseases such as lupus.

Primary Care Physician

Some people continue to have a primary care physician, such as a general internist or family practice physician, involved in their care.

There is a wide spectrum of potential involvement, with some primary care physicians acting as the coordinator of your lupus care, and others only managing care that is unrelated.

In general, it is very important to continue to see a primary care physician. Regular cancer screening examinations, such as Pap smears and colonoscopies, are no less important after you are diagnosed with lupus.

Mental Health Professional

Many people with lupus have a psychologist or psychiatrist as part of their care team.

They can help you find ways to cope with emotions you may be experiencing in relation to your disease and any limitations it has put on you. They can also address anxiety and depression, which are common in people with lupus.

Perinatologist

If you choose to try to become pregnant with lupus, you may have a perinatologist involved in your care. This is a doctor who specializes in high-risk pregnancies.

Though all pregnancies in people with lupus are considered high-risk, most are safe and result in healthy babies. A perinatologist can closely monitor a pregnancy along the way to make sure everything is going normally.⁴

Pathologists, Radiologists, and/or Surgeons

As noted earlier, biopsies are sometimes required to confirm a diagnosis of lupus. Some of these are done as a radiology procedure whereas others entail surgical biopsies.

A pathologist is the type of doctor who visualizes these specimens under a microscope and does testing to evaluate your disease.

A Word From Verywell

Most people with lupus will require care for their disease for the rest of their life, so it’s critical to find a health care team you respect and trust.

Playing an active role in your care as you work with them. Being your own advocate not only reduces the stress of living with lupus but may even make a difference in your outcome.²

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By Jeri Jewett-Tennant, MPH
Jeri Jewett-Tennant, MPH, is a medical writer and program development manager at the Center for Reducing Health Disparities.