Published Jun 08, 2022 in healthline.com
Author by Michael O’Regan

Immunologists and rheumatologists are both internal medicine doctors. While immunologists treat conditions that affect your immune system, rheumatologists specialize in the musculoskeletal system.

These two specialties sound pretty different, and you may be wondering why you may have to see both a rheumatologist and an immunologist.

Read on as we answer other questions you may have about immunologists and rheumatologists.

Difference between immunology and rheumatology

Immunologists are also sometimes called clinical immunologists or allergists. They work with all conditions caused by problems with your immune system:

• different types of allergies like hay fever, food allergies, and eczema
• asthma
• immunodeficiency disorders
• conditions related to allergies, asthma, and immunodeficiency disorders

Rheumatologists are also involved in the diagnosis and treatment of autoimmune conditions. But they’re also involved in conditions that affect the joints, like gout, in addition to your musculoskeletal system:

• muscles
• bones
• joints
• ligaments
• tendons

Conditions treated by rheumatologists include:

• rheumatoid arthritis
• lupus
• Sjögren’s syndrome
• psoriatic arthritis
• ankylosing spondylitis
• inflammatory bowel disease
• vasculitis

Where does the work of immunologists and rheumatologists overlap?

Even though there are plenty of differences in what parts of your body immunologists and rheumatologists are concerned with, there are similarities as well. The best example of this overlap is autoimmune diseases.

Autoimmune diseases often attack your musculoskeletal system, but it’s your immune system that’s responsible for these symptoms.

Although autoimmune diseases can attack any organ in your body, some of the most common autoimmune conditions affect your bones, muscles, and joints. These include:

• rheumatoid arthritis
• systemic lupus erythematosus (SLE), or simply lupus
• psoriatic arthritis
• Sjögren’s syndrome
• systemic sclerosis, or scleroderma

Rheumatologists and immunologists often team up to help resolve certain specific symptoms triggered by an autoimmune condition. Additionally, autoimmune conditions often set offTrusted Source allergies, asthma, or eczema. An immunologist can help you manage those.

What are the roles of immunologists and rheumatologists?

Although well-trained immunologists can recognize the symptoms of autoimmune diseases, rheumatologists are usually the go-to doctors when you need an accurate diagnosis. This is because the diagnosis of musculoskeletal autoimmune diseases is quite difficult and requires specialized training.

Once diagnosed, your rheumatologist will usually be the one to continue treating your condition. They may refer you to an immunologist if you develop an allergy or another symptom that needs to be checked out.

If you’re not sure which doctor you need to see first, you can always start with your primary care physician. These doctors are also trained to recognize the signs of autoimmune diseases and will refer you to the right specialist.

How much education and training do immunologists and rheumatologists get?

Rheumatologists and immunologists usually receive similar education, but there are some key distinctions.

Both professions complete a 4-year undergraduate degree, attend a 4-year medical school, and finish a 3-year residency in internal disease or pediatrics, depending on whether they want to treat children or adults. This is where similarities end.

After their residency, future rheumatologists must dedicate 2 to 3 years doing a rheumatology fellowship, followed by a certification test confirming their knowledge and skills in rheumatology.

Immunologists, on the other hand, complete a 2- to 3-year immunology fellowship, which ends with a certification test in immunology.

Both immunologists and rheumatologists are required to take continuing medical education courses in their fields of medicine. This is to ensure that doctors stay up to date on the latest medical research and information.

Should you see an immunologist or a rheumatologist?

It can sometimes be hard to figure out which specialist to see when you’re dealing with sudden health issues. Let’s discuss the key symptoms you should look out for when choosing the right doctor.

Who should see an immunologist

You should see an immunologist if:

• you have persistent allergies lasting several months out of the year
• your allergies cause other symptoms, like chronic sinus infections or difficulty breathing
• you have warning signs of asthma like frequent wheezing and coughing (especially after exercise), occasional shortness of breath, or tightness in the chest
• you’ve been previously diagnosed with asthma, and you have frequent asthma attacks despite taking asthma medications

Keep in mind that this isn’t a complete list, and your primary care doctor may recommend seeing an immunologist in other cases.

Who should see a rheumatologist

You should see a rheumatologist if:

• you experience pain in multiple joints, bones, or muscles
• you have new joint, bone, or muscle pain unrelated to any known injury
• you have joint, bone, or muscle pain accompanied by fever, fatigue, rashes, morning stiffness, or chest pain
• you have a chronic illness that other doctors have been unable to diagnose

Make sure to let your doctor know if you have relatives with an autoimmune or musculoskeletal disease or if your symptoms significantly worsen over a short period.

Other doctors who specialize in immune system problems

Because autoimmune diseases can affect any organ or tissue in your body, there are other doctors you may need to see if you deal with immune system issues. These include:

• endocrinologists, who diagnose and treat conditions related to your hormones
• gastroenterologists, or GI doctors, who specialize in gastrointestinal (GI) and liver diseases
• dermatologists, who are trained to recognize and treat diseases that affect your skin, hair, or nails
• neurologists, who diagnose and treat nerve problems
• hematologists, who specialize in diseases that affect your blood

How are autoimmune conditions diagnosed?

There’s no single test that can diagnose an autoimmune disease, and diagnosis can be a long and stressful journey. Your doctors will use a combination of lab tests, review your and your family’s medical history, and perform a thorough physical exam.

A lab test called antinuclear antibody test (ANA) is often one of the first tests a doctor might use if they suspect an autoimmune disease. But there are other tests doctors can use to confirm or rule out certain autoimmune conditions.

How are autoimmune conditions treated?

There’s no cure for autoimmune diseases, but some drugs can control your immune system and bring down pain and inflammation. These include:

• nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil, Midol) and naproxen (Aleve, Naprosyn)
• corticosteroids, like prednisone (Deltasone, Prednicot)
• immunosuppressant drugs

After the acute (initial) illness becomes managed, long-term immune modulation is not always needed. Lifestyle management, like eating a balanced diet and getting regular exercise, may also help you feel better.

Takeaway

While rheumatologists treat diseases of your musculoskeletal system, immunologists focus on your immune system. Both rheumatologists and immunologists can help if you’re dealing with an autoimmune disease that affects your muscles, bones, or joints.

Although there’s no cure for autoimmune diseases, doctors can prescribe drugs to bring down your pain and inflammation.