RHEUMATOLOGY is the medical specialty dealing with the diagnosis and treatment of rheumatic disorders — diseases causing inflammation of various joints, muscles, connective tissues, and organ systems. Rheumatic diseases are inherently complex since the symptoms may be nonspecific and involve nearly any bodily system. For example, lupus (a common rheumatologic condition) can involve the joints, skin, kidneys, lungs, heart, and central nervous system. Rheumatologists use highly specialized tests and imaging to treat patients in both office-based practices and hospital systems. Common rheumatologic conditions include rheumatoid arthritis, osteoarthritis, fibromyalgia, giant cell (temporal) arteritis, gout, lupus, polymyalgia rheumatica, psoriatic arthritis, scleroderma, and vasculitis. Prior to the last decade, the treatment of rheumatologic conditions predominantly relied upon nonsteroidal anti-inflammatories (NSAIDs), steroids (e.g. prednisone), and a variety of chronic medications such as methotrexate and hydroxychloroquine (Plaquenil). In the modern era, Rheumatologists rely upon a new group of drugs called “biologic response modifiers” or biologics. Biologics are genetically engineered drugs that inhibit specific components of the immune system to modify the course of various rheumatologic conditions. While biologics are associated with a number of severe risks including overwhelming infections, tuberculosis, and multiple sclerosis, they have revolutionized the treatment of numerous rheumatologic conditions and have evolved to become the standard of care as well as some of the most profitable pharmaceuticals of all time.
Medical malpractice involving Rheumatology physicians is highly complex. When it occurs, allegations may include delayed or improper treatment of a rheumatologic condition, as well as complications from the treatment itself. With the advent of biologics, treatment complications have led to increasing litigation in the area of product liability as well. More often, however, Rheumatologists are called as causation experts to explain the natural history of a rheumatologic process and how treatment affects outcome.