Cardiorheumatologist: who is this and how are rheumatology and cardiology connected

The word "cardiorheumatologist" requires explanation: it reflects the intersection of rheumatology — the diagnosis and treatment of rheumatic diseases — and cardiology, which deals with the heart. Below is what is known about the connection between these fields and when attention is paid to the heart in rheumatic disease.

What is known about the term

Rheumatology is a specialty of internal medicine: it deals with the diagnosis and treatment of rheumatic diseases, among which are inflammatory and degenerative-dystrophic diseases of the joints and spine, as well as systemic connective tissue diseases.

The connection is not formal: in rheumatoid arthritis, inflammation can affect not only the joints but also the eyes, skin, heart, nerves, blood, and lungs. Acute rheumatic fever, which mainly occurs in children, can leave permanent heart damage — rheumatic heart disease — and this sometimes manifests only years later.

Cardiologist and rheumatologist: what is the difference

A cardiologist deals with the heart, a rheumatologist with the joints, spine, and systemic connective tissue diseases. Rheumatology collaborates with cardiology, for example regarding rheumatic endocarditis.

In which rheumatic diseases the heart suffers

The list of rheumatic diseases is broad, and not all of them involve the heart. The heart may be involved in the following conditions:

• acute rheumatic fever and its consequences — acquired rheumatic heart valve disease, rheumatic endocarditis;
• rheumatic heart disease — permanent heart damage after rheumatic fever;
• rheumatoid arthritis: inflammation can affect the heart, lungs, eyes, skin, nerves, and blood.

When attention is paid to the heart in rheumatic disease

In rheumatic fever, symptoms usually appear 1–5 weeks after a bacterial throat infection: high fever, pain and swelling of the joints (more often the ankles, knees, wrists, and elbows), chest pain, shortness of breath and rapid heartbeat, involuntary twitching of the arms, legs, and face, small nodules under the skin, pale red spots on the arms and abdomen.

In rheumatoid arthritis, the joints ache and feel stiff on movement, worse in the morning or after immobility, and the involvement is symmetrical: if one hand is affected, so is the other. There may be redness and warmth around the joint, swelling makes it difficult to fasten clothing or bend the knees, and fatigue, fever, loss of appetite, and firm nodules under the skin near the joints are added.

A referral to a doctor for a rheumatic disease is not in itself a reason to call an ambulance. Emergency care is needed for life-threatening conditions, such as a heart attack or stroke. If chest pain, severe shortness of breath, rapid heartbeat appear, or the condition sharply worsens, call 103 or 112.

What examinations are prescribed at the appointment

There is no separate test that confirms rheumatoid arthritis: the disease develops gradually. The appointment begins with a discussion of complaints and family history, then an examination: the doctor checks the joints, looks for rash and nodules, and listens to the chest.

Next are blood tests and imaging (X-ray or ultrasound), including to rule out other causes similar to arthritis. Rheumatoid factor, antibodies to cyclic citrullinated peptide, antinuclear antibodies, C-reactive protein, ESR, complement testing, and synovial fluid analysis may be encountered. Based on the results, the doctor may refer you to a rheumatologist.

After rheumatic fever, regular check-ups are needed later, because heart damage may manifest years afterward. The risk of a repeat episode is higher in those who are younger.

It is useful to come to the appointment with questions: which joints hurt and for how long, whether there is chest pain, shortness of breath, heart palpitations, whether there have been rheumatic diseases in the family, and what examinations have already been done. The material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer